Page 135 - Biomarkers for risk stratification and guidance in heart failure
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Chapter 6
These differences in patient baseline characteristics and renal function at hospital discharge seemed to be mainly caused by change in NT-proBNP. For example, in patients with an increase in eGFR, those with an increase in NT-proBNP had higher incidence of myocardial infarction compared to those with a decrease in NT-proBNP (52% versus 27%, see table 1). Interestingly, NT-proBNP concentration at hospital discharge did not differ between all groups.
Prediction of outcome
Median time from hospital discharge to the outpatient visit one month after discharge was 30 days (IQR 26 – 36 days). All surviving patients included for this analysis had a follow-up duration of 365 days after the outpatient visit one month after hospital discharge.
At 90-days follow-up, 47 patients (17.3%) had reached the combined endpoint of HF readmission or mortality and 14 patients (5.2%) had died. After one year, 95 patients (35.1%) had reached the combined endpoint and 51 patients (18.8%) had died.
Outcome per group based on increase versus decrease in NT-proBNP and eGFR is depicted in table 2 and figures 1a and b. Patients with a decrease in NT-proBNP had reasonable short- and long-term prognosis with no change in outcome between those having a decrease versus increase in eGFR. In patients with an increase in NT-proBNP outcome was worse compared to those with a decrease in NT-proBNP, but again no significant difference was seen between patients with a decrease versus increase in eGFR.
Table 2. Outcome divided by change in NT-proBNP and eGFR.
Outcome
n
HF related admission / mortality, n (%) - 90 days
- 180 days - 365 days
Mortality, n (%) - 90 days
- 180 days - 365 days
HF = heart failure
NBNP NBNP NBNP NBNP
eGFR eGFR eGFR eGFR
P overall
<0.0001 <0.0001 <0.0001
0.101 0.048 0.001
2 (3.6) 5 (9.1) 7 (12.7)
1 (1.8) 2 (3.6) 5 (9.1)
5 (7.1)
8 (11.4) 10 (14.3)
1 (1.4) 4 (5.7) 6 (8.6)
17 (24.6) 26 (37.7) 33 (47.8)
6 (8.7) 10 (14.5) 16 (23.2)
23 (29.9) 31 (40.3) 45 (58.4)
6 (7.8) 12 (15.6) 24 (31.2)
55 70 69 77
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