Page 115 - Biomarkers for risk stratification and guidance in heart failure

Chapter 5
acutely decompensated HF is related to hemodynamic improvement12 and is thereby a marker of success of HF treatment during admission. It is therefore not surprising that the extent of decrease in NT-proBNP during admission reflects outpatient outcome after discharge. Our findings go beyond these conclusions, showing that inpatient changes in NT-proBNP are of prognostic importance independently from early outpatient changes as well as independently from NT- proBNP levels measured at 1 month after hospital discharge.
In contrast to inpatient change in NT-proBNP, NT-proBNP concentration at discharge failed to retain prognostic impact in multivariate analysis.
The presence of strong correlations between the absolute NT-proBNP concentrations will certainly have influenced the selection process in multivariate analysis that led to the uptake of NT-proBNP concentration at 1 month after hospital discharge over NT-proBNP at hospital discharge (Supplemental Table 1). However, the fact that NT-proBNP concentration 1 month after hospital discharge remained the strongest prognostic NT-proBNP value is not surprising, because it is the most recent measurement. This is also shown by univariate analysis: NT- proBNP concentration 1 month after hospital discharge yielded the highest Wald score for mortality (15.6 vs 15.2 for NT-proBNP at discharge).
No. at risk
Follow-up (days)
62 62 62 62 54
94 91 85 81 67
83 73 67 62 43
70 55 47 47 38
114