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B-Type Natriuretic Peptide Levels and Mortality in Patients With and Without Heart Failure
Michelle K York1, Deepak K Gupta1, Cassandra F Reynolds1
1Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
B-type natriuretic peptide (BNP) predicts mortality in heart failure (HF) patients. This study found BNP also predicts death in non-HF patients, with similar risk levels across both groups, especially in acute care settings.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- Circulating B-type natriuretic peptide (BNP) concentrations are established predictors of mortality in patients with heart failure (HF).
- Both cardiac and extracardiac factors influence BNP levels, suggesting potential prognostic utility beyond HF.
- This study investigates the prognostic value of BNP in patients both with and without a diagnosis of HF.
Purpose of the Study:
- To compare the prognostic value of plasma BNP levels for mortality prediction in patients with and without heart failure.
- To determine if BNP is a significant predictor of death in individuals without HF.
- To assess the similarity in mortality risk associated with specific BNP levels between HF and non-HF patient cohorts.
Main Methods:
- A retrospective analysis of 30,487 patients with a first plasma BNP measurement from 2002-2013 at Vanderbilt University Medical Center.
- Patient data included demographics, clinical characteristics, HF status, and follow-up through 2015.
- Multivariate Cox proportional hazards models were used to quantify the risk for death based on BNP levels, adjusting for covariates.
Main Results:
- BNP levels were significantly lower in patients without HF (median 89 pg/ml) compared to those with HF (median 388 pg/ml).
- Over 90,898 person-years, 31% of non-HF patients and 53% of HF patients died.
- In multivariate models, BNP and age were the strongest predictors of death in both groups. The risk for death associated with a given BNP level was similar between patients with and without HF, particularly in acute care settings.
Conclusions:
- Plasma BNP level is a stronger predictor of death than traditional risk factors among patients without HF.
- The risk for death associated with any specific BNP level is comparable between patients with and without HF.
- These findings highlight the broad prognostic utility of BNP, especially in acute care settings.
Background:
Circulating B-type natriuretic peptide (BNP) concentrations strongly predict mortality in patients with heart failure (HF). Both cardiac and extracardiac stimuli influence BNP levels, suggesting that BNP might have similar prognostic value in patients without HF.
Objectives:
The aim of this study was to compare the prognostic value of BNP between patients with and those without HF.
Methods:
Using the Vanderbilt University Medical Center electronic health record, 30,487 patients (median age 63 years, 50% men, 17% black, 38% with HF) who had a first plasma BNP measurement between 2002 and 2013, with follow-up through 2015, were studied. The risk for death according to BNP level was quantified using multivariate Cox proportional hazards models.
Results:
BNP levels were lower in patients without HF (median 89 pg/ml; interquartile range: 34 to 238 pg/ml) compared with those with HF (median 388 pg/ml; interquartile range: 150 to 940 pg/ml) (p < 0.0001). Over 90,898 person-years of follow-up, 5,903 patients without HF (31%) and 6,181 patients with HF (53%) died. In multivariate models including demographic and clinical characteristics, BNP and age were the strongest predictors of death in both patients with and those without HF. In acute care settings and even among outpatients with modestly elevated BNP, the risk for death according to BNP was similar between patients with and those without HF. For instance, a BNP level of 400 pg/ml was associated with a 3-year risk for death of 21% (95% confidence interval: 20% to 23%) and 19% (95% confidence interval: 17% to 20%) in patients with and those without HF, respectively.
Conclusions:
Among patients without HF, plasma BNP level is a stronger predictor of death than traditional risk factors. The risk for death associated with any given BNP level is similar between patients with and those without HF, particularly in the acute care setting.
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