- 作者：Domenico Scrutinio ; Enrico Ammirati ; Pietro Guida ; Andrea Passantino ; Rosa Raimondo ; Valentina Guida ; Simona Sarzi Braga ; Roberto FE Pedretti ; Rocco Lagioia ; Maria Frigerio ; Raffaella Catanzaro ; Fabrizio Oliva
- 关键词：Acute heart failure ; N-terminal pro-B-type natriuretic peptide ; Prognosis ; Risk stratification
- 刊名：International Journal of Cardiology
- 出版年：2013
- 出版时间：3 October, 2013
- 年：2013
- 卷：168
- 期：3
- 页码：2120-2126
- 全文大小：542 K
Background
NT-proBNP has been associated with prognosis in acute decompensated heart failure (ADHF). Whether NT-proBNP provides additional prognostic information beyond that obtained from standard clinical variables is uncertain. We sought to assess whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) determination improves risk reclassification of patients with ADHF and to develop and validate a point-based NT-proBNP risk score.Methods
This study included 824 patients with ADHF (453 in the derivation cohort, 371 in the validation cohort). We compared two multivariable models predicting 1-year all-cause mortality, including clinical variables and clinical variables plus NT-proBNP. We calculated the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI). Then, we developed and externally validated the NT-proBNP risk score.
Results
One-year mortalities for the derivation and validation cohorts were 28.3 % and 23.4 % , respectively. Multivariable predictors of mortality included chronic obstructive pulmonary disease, estimated glomerular filtration rate, sodium, hemoglobin, left ventricular ejection fraction, and moderate to severe tricuspid regurgitation. Adding NT-proBNP to the clinical variables only model significantly improved the NRI (0.129; p = 0.0027) and the IDI (0.037; p = 0.0005). In the derivation cohort, the NT-proBNP risk score had a C index of 0.839 (95 % CI: 0.798-0.880) and the Hosmer-Lemeshow statistic was 1.23 (p = 0.542), indicating good calibration. In the validation cohort, the risk score had a C index of 0.768 (95 % CI: 0.711-0.817); the Hosmer-Lemeshow statistic was 2.76 (p = 0.251), after recalibration.
Conclusions
The NT-proBNP risk score provides clinicians with a contemporary, accurate, easy-to-use, and validated predictive tool. Further validation in other datasets is advisable.