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Prediction of clinical outcomes using B-type natriuretic peptides in the general population: a systematic review
Andrew C Don-Wauchope1, Pasqualina L Santaguida, Robert McKelvie
1Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
Insights
N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in the general population. However, prospective studies are needed to confirm its clinical utility for risk stratification.
Area of Science:
- Biomarkers in Cardiovascular Health
- Predictive Analytics in General Populations
Background:
- B-type natriuretic peptides (BNPs) are investigated for outcome prediction in general populations.
- Previous reviews suggest BNP association with clinical outcomes in cardiovascular disease subgroups.
Purpose of the Study:
- To systematically review primary studies on B-type natriuretic peptides for outcome prediction in general populations.
- To assess the association of NT-proBNP with clinical outcomes and its utility in risk stratification.
Main Methods:
- Systematic search of multiple databases (Medline, Embase, AMED, Cochrane) for English articles (1989-2012).
- Inclusion and data extraction by trained reviewers using standardized forms.
- Included studies defined general population as randomly selected from community settings without specific criteria.
Main Results:
- Seven studies using FDA-approved NT-proBNP assays were included.
- Hazard ratios for outcome prediction ranged from 1.0 to 4.1 (all p<0.05).
- Four studies showed statistically significant improvements in outcome prediction via discrimination statistics.
Conclusions:
- NT-proBNP is associated with heart failure, mortality, and cardiovascular events in the general population.
- Discrimination statistics suggest modest improvements in risk stratification.
- No prospective studies currently demonstrate the clinical utility of BNP for predicting outcomes in general populations.
Abstract:
The use of B-type natriuretic peptides to predict outcomes in general populations has been investigated in a number of primary studies. A previous systematic review considering natriuretic peptides in cardiovascular disease included a subgroup of general population studies, which suggested an association with a number of clinical outcomes. We electronically searched Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and mid-2012. We utilized trained reviewers and standardized forms to screen articles for inclusion and extract data from included articles. All included studies (n = 7) were summarized in narrative and tabular form. A general population was defined as one that was randomly selected from a community setting where no specific inclusion or exclusion criteria were specified. The seven included studies all used FDA approved assays for NT-proBNP. The range of clinical outcomes and heterogeneity did not allow for meta-analysis. The hazard ratios for predicting outcomes in the included studies ranged from 1.0 to 4.1 (all p values <0.05). The discrimination statistics reported in four studies all demonstrated statistically significant improvements in predicting outcomes. NT-proBNP is associated with heart failure, all-cause and cardiovascular mortality, and other combined cardiovascular events in a general unselected population. The discrimination statistics suggest modest improvements in risk stratification. No prospective studies exist to demonstrate the clinical utility of using B-type natriuretic peptides to predict clinical outcomes in a general population.
