Key result
Elevated ICU admission NT-pro-BNP predicts hospital mortality but adds minimal prognostic value to SAPS 3.
Why the study?
The role of NT-pro-BNP as a prognostic factor in ICU patients is not yet fully established.
Observational (n=1,440)
Yes
Effect estimate: AUC 0.67 (95% CI 0.64-0.70)
Absolute Event Rate: 0.67% vs 0.83%
p-value: p=<0.001
NT-proBNP adds little to SAPS 3 for ICU mortality prediction; leaves open its utility in dynamic monitoring or subgroups.
BACKGROUND: The role of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as a prognostic factor in patients admitted to the intensive care unit (ICU) is not yet fully established. We aimed to determine whether NT-pro-BNP is predictive of ICU mortality in a multicenter cohort of critically ill patients. METHODS: A total of 1440 patients admitted to 22 ICUs (medical, 14; surgical, six; multidisciplinary, two) in 15 tertiary or university-affiliated hospitals between July 2010 and January 2011 were assessed. Patient data, including NT-pro-BNP levels and Simplified Acute Physiology Score (SAPS) 3 scores, were recorded prospectively in a web-based database. RESULTS: The median age was 64 years (range, 53-73 years), and 906 (62.9%) patients were male. The median NT-pro-BNP level was 341 pg/mL (104-1,637 pg/mL), and the median SAPS 3 score was 57 (range, 47-69). The ICU mortality rate was 18.9%, and hospital mortality was 24.5%. Hospital survivors showed significantly lower NT-pro-BNP values than nonsurvivors (245 pg/mL [range, 82-1,053 pg/mL] vs. 875 pg/mL [241-5,000 pg/mL], respectively; p < 0.001). In prediction of hospital mortality, the area under the curve (AUC) for NT-pro-BNP was 0.67 (95% confidence interval [CI], 0.64-0.70) and SAPS 3 score was 0.83 (95% CI, 0.81-0.85). AUC increment by adding NT-pro-BNP is minimal and likely no different to SAPS 3 alone. CONCLUSIONS: The NT-pro-BNP level was more elevated in nonsurvivors in a multicenter cohort of critically ill patients. However, there was little additional prognostic power when adding NT-pro-BNP to SAPS 3 score.
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Rhee et al. (2014) conducted an observational in Critical illness requiring ICU admission (n=1,440). N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) vs. SAPS 3 score was evaluated on Prediction of hospital mortality (AUC) (AUC 0.67, 95% CI 0.64-0.70, p=<0.001). Elevated NT-pro-BNP levels on ICU admission predicted hospital mortality with an AUC of 0.67, but provided minimal additional prognostic power when added to the SAPS 3 score.
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