Key result
In patients with congestive heart failure discharged after acute decompensation, a BNP at discharge ≥ 250 pg/ml combined with plasma creatinine > 1.5 mg/dl strongly predicted mid-term adverse clinical outcomes (p=0.0001).
Cohort (n=237)
No
p-value: p=0.0001
In patients discharged after acute decompensated heart failure, a discharge BNP ≥ 250 pg/ml combined with plasma creatinine > 1.5 mg/dl are strong predictors of adverse mid-term clinical outcomes.
INTRODUCTION: Risk stratification in congestive heart failure (CHF) patients is based on a variety of clinical and laboratory variables. We analysed renal function, BNP, water composition, echocardiographic and functional determinations in predicting mid-term outcome in CHF patients discharged after decompensation. MATERIAL AND METHODS: All subjects with NYHA class II-IV were enrolled at hospital discharge. NYHA class, BNP, water body composition, non-invasive cardiac output and echocardiogram were analysed. Death, cardiac transplantation and hospital readmission for CHF were scheduled. RESULTS: Two-hundred and thirty-seven (64.5% males, age 71.1±10.1) patients were discharged after obtaining normal hydration; left ventricular ejection fraction (LVEF) was 43.2±16.2%, cardiac output was 3.8±1.1 l/min and BNP at discharge resulted 401.3±501.7 pg/ml. During the 14-month follow-up 15 patients (6.3%) died, 1 (0.4%) underwent cardiac transplantation and 18 (7.6%) were readmitted for CHF (event group); in 203 (85.6%) no events were observed (no-event group). Higher NYHA class (2.1±0.7 vs. 1.9±0.4, p=0.01), BNP at discharge (750.2±527.3 pg/ml vs. 340.7±474.3 pg/ml, p=0.002) and impaired LVEF (33.7±15.7% vs. 44.5±15.8%, p=0.0001) and creatinine (1.7±0.6 vs. 1.2±0.8 mg/dl, p=0.004) were noticed in the event group. At multivariate Cox analysis LVEF (p=0.0009), plasma creatinine (p=0.006) and BNP at discharge (p=0.001) were associated with adverse mid-term outcome. Kaplan-Meier survival curves demonstrated that adding cut-off points for creatinine 1.5 mg/dl and discharged BNP of 250 pg/ml discriminated significantly prognosis (p=0.0001; log rank 21.09). CONCLUSIONS: In predicting mid-term clinical prognosis in CHF patients discharged after acute decompensation, BNP at discharge ≥ 250 pg/ml added with plasma creatinine > 1.5 mg/dl are strong adverse predictors.
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Feola et al. (2012) conducted a cohort in Congestive heart failure (n=237). BNP at discharge ≥ 250 pg/ml and plasma creatinine > 1.5 mg/dl vs. BNP < 250 pg/ml and plasma creatinine ≤ 1.5 mg/dl was evaluated on Composite of death, cardiac transplantation, and hospital readmission for CHF (p=0.0001). In patients with congestive heart failure discharged after acute decompensation, a BNP at discharge ≥ 250 pg/ml combined with plasma creatinine > 1.5 mg/dl strongly predicted mid-term adverse clinical outcomes (p=0.0001).
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