Key result
Adding NT-proBNP to clinical variables improves the C-statistic for HF prediction in CKD to ~0.78.
Why the study?
The complementary prognostic role of NT-proBNP and eGFR for predicting heart failure in adults with and without chronic kidney disease was unclear.
Does the addition of NT-proBNP and eGFR to clinical risk variables improve 5-year heart failure risk prediction in adults without baseline cardiovascular disease?
Cohort (n=5,504)
Yes
Does the addition of NT-proBNP and eGFR to clinical risk variables improve 5-year heart failure risk prediction in adults without baseline cardiovascular disease?
Absolute Event Rate: 0.78% vs 0.71%
p-value: p=0.04
The addition of NT-proBNP, but not eGFR, to established clinical risk variables significantly improves 5-year heart failure risk prediction in adults without baseline cardiovascular disease, regardless of CKD status.
May refine HF risk stratification in CKD; extends models but remains hypothesis-generating pending validation.
BACKGROUND: This study examined the complementary prognostic role of NT-proBNP and eGFR for predicting heart failure (HF) in adults with and without chronic kidney disease (CKD) defined as eGFR<60 ml/min/1.73m2. METHODS: We used data from the Multi-Ethnic Study of Atherosclerosis, a cohort of 6814 adults without baseline clinical cardiovascular disease. Five-year risk prediction of HF based on clinical HF risk variables (HFRV) plus NT-proBNP, eGFR or both was assessed using the C-statistic and the net reclassification index (NRI) after stratifying by CKD status. RESULTS: Mean age at baseline was 62.3±10.3 years and CKD were present in 5.9%. A total of 39 and 180 HF events occurred in participants with and without CKD, respectively. Among adults with CKD, the C-statistic for HF risk prediction increased significantly (P =0.04) from 0.71 (95% CI 0.64, 0.78) with HFRV alone to 0.78 (95% CI 0.71, 0.85) with addition of NT-proBNP. In the non-CKD group, the C-statistic increased from 0.77 (95% CI 0.74, 0.80) with HFRV alone to 0.83 (95% CI 0.80, 0.85) with addition of NT-proBNP. Further addition of eGFR to the model did not alter the C-statistic regardless of CKD status. NRI improved by 23.1% and 10.2% in CKD and non-CKD, respectively, with the addition of NT-proBNP alone and findings were similar when both eGFR and NT-proBNP were both added to model. CONCLUSIONS: In adults without clinical cardiovascular disease, the addition of NT-proBNP but not eGFR to established HFRV improves HF risk prediction in adults with and without CKD.
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Syed et al. (2018) conducted a cohort in Heart failure (n=5,504). Addition of NT-proBNP to clinical heart failure risk variables vs. Clinical heart failure risk variables alone was evaluated on C-statistic for 5-year heart failure risk prediction in adults with chronic kidney disease (95% CI 0.71-0.85, p=0.04). The addition of NT-proBNP to established clinical risk variables significantly improved the C-statistic for heart failure risk prediction from 0.71 to 0.78 in adults with chronic kidney disease.
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