Novel age-stratified NT-proBNP cut points maintained 82% sensitivity and 74% specificity for acute heart failure diagnosis in CKD patients, who had a higher risk of 90-day MACE (HR 1.539, P<0.001).
Cohort (n=2,384)
Yes
Do novel age-stratified NT-proBNP cut points maintain diagnostic accuracy and prognostic value for acute heart failure in emergency department patients with chronic kidney disease?
Using higher, age-stratified NT-proBNP cut points in patients with chronic kidney disease preserves diagnostic accuracy for acute heart failure and effectively stratifies 90-day risk of major adverse cardiovascular events.
Hazard Ratio: 1.539
p-value: p=< 0.001
Abstract Background Diagnosing acute heart failure (HF) in patients with chronic kidney disease (CKD) is challenging due to the impact of CKD on NT-proBNP levels. Purpose This study evaluates the impact of CKD on NT-proBNP-based HF diagnosis using novel age-stratified cut points and assesses diagnostic performance. Methods The PRECISE-HF study prospectively enrolled emergency department (ED) patients across 17 U.S. sites. NT-proBNP concentrations were measured using a novel automated assay. Diagnostic performance was assessed in CKD patients (eGFR 60 mL/min/1.73m²) using revised age-stratified cut points: ≥750 ng/L (50 years), ≥1550 ng/L (50–75 years), and ≥1700 ng/L (75 years). MACE (major adverse events; defined as death, myocardial infarction, or stroke) were evaluated at 90 days. Sensitivity, specificity, AUC, and Cox proportional hazard ratios were analyzed. Results Of 2,384 patients meeting enrollment criteria, 14.2% had CKD. Applying the novel cut points in patients with CKD maintained specifcity (74%) with overlapping confidence intervals for both sensitivity (82%) and specificity. AUC values for HF diagnosis were 0.88 (50 years), 0.87 (50–75 years), and 0.83 (75 years), demonstrating robust diagnostic performance across age groups. In patients with CKD, rates of mortality from MACE were significantly higher in those with NTproBNP results greater than or equal to their respective age stratified cutpoint (750, 1550, and 1700 ng/L) in subjects with acute Heart Failure (Log rank P value 0.01). A Cox proportional hazards model showed increased risk for patients with CKD compared to those without (1.539; P 0.001). Conclusions Adjusting NT-proBNP rule-in thresholds for CKD patients preserves diagnostic accuracy and prognostic association. The novel cut points enhance HF diagnosis in renal impairment, supporting more precise clinical decision-making in this high-risk population.Rule-in performance with CKD Mortality KM for New CKD Cutpoints
Allen et al. (Sat,) conducted a cohort in Acute heart failure in patients with chronic kidney disease (n=2,384). Novel age-stratified NT-proBNP cut points vs. Patients without CKD was evaluated on Acute heart failure diagnosis and 90-day MACE (death, myocardial infarction, or stroke) (HR 1.539, p=< 0.001). Novel age-stratified NT-proBNP cut points maintained 82% sensitivity and 74% specificity for acute heart failure diagnosis in CKD patients, who had a higher risk of 90-day MACE (HR 1.539, P<0.001).