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Serum NT-ProBNP/Chloride Ratio Predicts Adverse Cardiovascular Outcomes in Patients with Acute Heart Failure
Victor José Leal-Alcántara1, Eder González-Macedo1, Ana Cristina Maldonado-May1
1Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City 14080, Mexico.
Insights
The serum NT-proBNP/chloride ratio effectively predicts cardiovascular events in acute decompensated heart failure (HF) patients. This simple test identifies high-risk individuals needing closer monitoring for better outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Prediction
Background:
- Heart failure (HF) is a significant public health concern, being a leading cause of hospitalization, especially in older adults.
- There is a critical need for tools to predict adverse outcomes in patients diagnosed with HF.
- Acute decompensated heart failure (ADHF) requires effective prognostic indicators to guide patient management.
Purpose of the Study:
- To investigate the prognostic value of the serum NT-proBNP/chloride ratio in predicting major cardiovascular events in patients with ADHF.
- To assess whether this ratio can serve as a novel biomarker for risk stratification in ADHF.
- To compare the predictive power of the NT-proBNP/chloride ratio against NT-proBNP or chloride levels alone.
Main Methods:
- Retrospective analysis of 197 patients with confirmed acute decompensated heart failure.
- Patients were stratified based on their admission serum NT-proBNP/chloride ratio, categorized as above or below the median (83).
- The primary composite endpoint included cardiovascular mortality, HF readmission, and emergency department visits; follow-up was approximately 92 days.
Main Results:
- A high NT-proBNP/chloride ratio was associated with poorer baseline characteristics, including lower LVEF and higher BUN and creatinine.
- Patients with a high ratio demonstrated a significantly increased risk (HR 3.18) of the primary composite endpoint.
- Multivariate analysis confirmed the NT-proBNP/chloride ratio (p=0.02) and diastolic pressure (p=0.037) as independent predictors; ROC analysis showed superior predictive performance compared to individual markers.
Conclusions:
- The serum NT-proBNP/chloride ratio is a novel and easily applicable predictor of cardiovascular events in patients with acute decompensated heart failure.
- This ratio offers valuable prognostic information for short- and medium-term risk assessment in ADHF.
- The findings support the clinical utility of the NT-proBNP/chloride ratio for risk stratification and management of ADHF patients.
Abstract:
Background: Heart failure (HF) is a public health issue. It represents the second most common cause of hospitalization and the leading cause in individuals over 60 years old. Tools that predict adverse outcomes in patients with HF are needed. Objective: This study analyzed the prognostic role of the serum NT-proBNP/chloride ratio as a predictor of major cardiovascular events in patients with acute decompensated HF. Methods: Patients with a confirmed diagnosis of acute decompensated heart failure were retrospectively enrolled in the study; admission NT-proBNP/chloride ratio was used to stratify patients above or below the median (>/<83). The primary composite endpoint consisted of cardiovascular mortality, decompensated HF readmission, and unplanned emergency department visits. Results: A total of 197 individuals were included, of whom 100 (50.7%) were classified above and 97 (49.2%) below the median. Patients showing a high ratio had a lower LVEF (31 vs. 39%), a higher proportion of previous MI (30 vs. 15%), a lower diastolic blood pressure (73 vs. 80 mmHg), and higher BUN (38 vs. 23 mg/dL) and creatinine (1.6 vs. 1.1 mg/dL). After a follow-up period of 92 ± 3 days, 46 patients (23%) presented the primary endpoint; those with a high NT-proBNP/chloride ratio showed an increased risk (HR 3.18, 95% CI 1.55-6.52, p = 0.0015) of the primary endpoint. After multivariate analysis, only serum NT-proBNP/chloride ratio (p = 0.02) and diastolic pressure (0.037) remained significant. The area under the ROC curve for the NT-proBNP/chloride ratio for predicting the primary composite endpoint was significantly superior when compared with AUC for NT-proBNP or chloride alone. Conclusions: The serum NT-proBNP/chloride ratio is a novel, easy to use predictor of short- and medium-term cardiovascular events in patients with acute decompensated HF.
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