Preprint Article Version 1 NOT YET PEER-REVIEWED

Difference between Serum BNP Admission Level and that Detected at Discharge in Patients with ADHF Predicts Six-Month Mortality in a More Reliable Manner with Respect to Isolated BNP Determination Taken on Admission

  1. Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, ASL Napoli 1 Centro, Napoli, Italy
  2. 1 Cardiology Unit, Presidio Sanitario Intermedio “Elena d’Aosta”, ASL Napoli 1 Centro, Napoli, Italy
  3. Division of Cardiology, Casa di Cura “Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
  4. Heart Department, Interventional Cardiology, A.O.U. “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
Version 1 : Received: 8 August 2016 / Approved: 9 August 2016 / Online: 9 August 2016 (11:33:03 CEST)

How to cite: De Vecchis, R.; Ariano, C.; Baldi, C. Difference between Serum BNP Admission Level and that Detected at Discharge in Patients with ADHF Predicts Six-Month Mortality in a More Reliable Manner with Respect to Isolated BNP Determination Taken on Admission. Preprints 2016, 2016080087 (doi: 10.20944/preprints201608.0087.v1). De Vecchis, R.; Ariano, C.; Baldi, C. Difference between Serum BNP Admission Level and that Detected at Discharge in Patients with ADHF Predicts Six-Month Mortality in a More Reliable Manner with Respect to Isolated BNP Determination Taken on Admission. Preprints 2016, 2016080087 (doi: 10.20944/preprints201608.0087.v1).

Abstract

Background According to some authors, a single isolated measurement of serum BNP executed on hospital admission would not be a sufficiently accurate method to predict the outcome of patients with ADHF. Aims For verifying this assumption, a retrospective study was conducted on patients hospitalized for ADHF. Our main objective was to ascertain whether there was any difference in midterm mortality among patients with rising BNP at discharge as compared to those with decreasing BNP at discharge. Methods Medical records were examined so as to make a partition of the ADHF patient population into two groups, the former characterized by a rise in BNP during hospitalization, and the latter exhibiting a decrease in BNP in the measurement taken at hospital discharge. Results 177 patients were enrolled in a retrospective study. Among them, 53 patients (29.94%) had increased BNPs at the time of discharge, whereas 124 (70.06%) showed decreases in serum BNP during their hospital stay. The group with patients who exhibited BNP increases at the time of discharge had higher degree of congestion evident in the higher frequency of persistent jugular venous distention and persistent orthopnea at discharge. Moreover, patients with increased BNP at the time of discharge had a lower reduction in inferior vena cava maximum diameter [1.58 ± 2.2 mm vs. 6.32 ± 1.82 mm; p (one-way ANOVA)=0.001]. In contrast, there was no significant difference in weight loss when patients with increased BNP at discharge were compared to those with no such increase. A total of 14 patients (7.9%) died during the six-month follow-up period. Cox proportional hazard analysis revealed that BNP increase at the time of discharge was an independent predictor of six-month all-cause mortality after adjustment for age, sodium at discharge, creatinine at discharge and New York Heart Association (NYHA) class at discharge (hazard ratio 34.49; 95% confidence intervals: 4.55–261.06; P =0.001). Conclusions Among patients with history of ADHF, more elevated BNP levels at the time of discharge from the hospital compared to those detected at admission identify a patient subset with higher grade of congestion and higher six-month mortality.

Subject Areas

natriuretic peptides; heart failure; congestion; outcome

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