Dataset Information

In-hospital mortality is associated with high NT-proBNP level.

ABSTRACT:

Objective

To compare in-hospital mortality in unselected adult patients according to N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.

Method

Retrospective study including 3833 adult patients (median age 72 years, 45% women) hospitalized between January 2013 and April 2015 in a Swiss university hospital, with at least one NT-proBNP level measurement during hospitalization. Patients were categorized in quintiles regarding their highest NT-proBNP level. In-hospital mortality and length of stay (LOS) were compared between the highest and the other quintiles.

Results

In-hospital mortality rate and LOS (average±standard deviation) were higher in the fifth quintile than in the others (6.5% vs 20.3%, and 20.8±24.0 vs. 14.9±26.5 days respectively, both p<0.001). After multivariate adjustment on age, gender, principal diagnoses, stage 5 renal failure and type of management, patients in the fifth quintile had a hazard ratio [95% confidence interval] of 1.97 [1.57-2.46] for in-hospital mortality and an adjusted LOS (average±standard error) of 20.4±1.0 vs. 14.9±0.5 days for the other quintiles (p<0.001). Further stratification on the main diagnosis at discharge led to similar findings.

Conclusion

Patients with high levels of NT-proBNP are at higher risk of in-hospital mortality and longer LOS, regardless of their clinical characteristics. NT-proBNP level can be a helpful tool for predicting in-hospital patient outcome in unselected adult patients.

SUBMITTER: Benmachiche M

PROVIDER: S-EPMC6224094 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is an important biomarker for the diagnosis of heart failure. Apart from this and only recently recognized, NT-proBNP levels associate with higher HDL- and lower LDL-cholesterol levels comprising a favorable blood lipid profile. To further examine this observation, the lipoprotein profile in relation to NT-proBNP was examined in-depth by proton nuclear magnetic resonance spectroscopy (1H-NMR). We complemented this investigation with a state-of-the-art untargeted metabolomics approach. METHODS:Lipoprotein particles were determined by 1H-NMR spectroscopy in 872 subjects without self-reported diabetes from the population-based Study of Health in Pomerania (SHIP)-TREND with available NT-proBNP measurements. Comprehensive metabolomics data for plasma and urine samples were obtained. Linear regression models were performed to assess the associations between serum concentrations of NT-proBNP and the metabolites/lipoprotein particles measured in plasma or urine. RESULTS:An increase in serum NT-proBNP was associated with a benefical lipoprotein profile, including a decrease in VLDL, IDL and LDL-particles along with an increase in large HDL particles. These findings were replicated in a second independent cohort. Serum concentrations of NT-proBNP showed significant inverse associations with seven plasma metabolites while associations with 39 urinary metabolites, mostly comprising amino acids and related intermediates, were identified. Mediation analyses revealed adiponection as mediating factor for the associations observed with lipoproteins particles. CONCLUSIONS:Most of the metabolic changes associated with NT-proBNP implicate significant influence on the blood lipid profile besides vasodilatory and the diuretic action of BNP signaling. Our data suggest that the more favorable lipoprotein profile as associated with elevated NT-proBNP concentrations in mainly cardiac healthy individuals might relate to adiponectin signaling indicating even indirect cardio-protective effects for NT-proBNP.