%0 Journal Article
%T Predictive Value of Admission N-Terminal Pro-B-Type Natriuretic Peptide and Renal Function in Older People Hospitalized for Dyspnoea
%A Fabio Fabbian
%A Alfredo De Giorgi
%A Marco Pala
%A Stefano Volpato
%A Francesco Portaluppi
%A Giovanni Zuliani
%A Roberto Manfredini
%J Disease Markers
%D 2013
%R 10.1155/2013/687467
%X Background. We investigated the relationship between NT-pro-BNP, glomerular filtration rate (GFR), and all-cause mortality rates in a cohort of older people discharged from an internal medicine unit after admission for dyspnoea. Patients and Methods. NT-pro-BNP was evaluated in serum samples of 134 patients aged 80 ㊣ 6 years who presented to a single academic centre with worsening dyspnoea. History data and anthropometric, clinical, and biochemical parameters including GFR were collected at the time of admission. 119 out of 134 were discharged alive from hospital and were included in the follow-up of 779 ㊣ 370 days. Results. 35 out of 119 subjects died after a follow-up of 266 ㊣ 251 days. Cox proportional hazards model showed that GFR and Ln (NT-pro-BNP) were predictors for all-cause mortality with estimated hazard ratios of 0.969 (95% confidence interval: 0.950每0.988; ) and 2.360 (95% confidence interval: 1.208每4.610; ), respectively. Patients characterized by high NT-pro-BNP levels and GFR ≡ 60ˋmL/min/1.73ˋm2 showed a dramatic reduction in survival duration compared with the groups with different combinations of the two variables ( ). Conclusions. In the elderly, NT-pro-BNP and GFR are predictors of all-cause mortality after admission because of dyspnoea. Since the fact that subjects with high NT-pro-BNP and GFR 60ˋmL/min/1.73ˋm2 exhibited a reduced survival, high admission NT-pro-BNP suggests future negative outcome. 1. Introduction N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) plasma levels are assessed in patients who present acutely with dyspnoea. NT-pro-BNP plasma levels are related to the severity of congestive heart failure (CHF) [1], and they are evaluated in order to diagnose CHF in older subjects aged 70 years [2]. Moreover, NT-pro-BNP levels have been found to predict incident disability in older people. In a recent Japanese study, participants were classified into five groups based on their NT-pro-BNP plasma levels (<47, 47每77, 77每133, 133每241, and >241ˋpg/mL, resp.), and the authors demonstrated that the combined rate of incident disability/death was higher in those with high NT-pro-BNP values [3]. Again, assessment of natriuretic peptide after myocardial infarction is a good indicator of infarct size and left ventricle function [4], probaly due to its overexpression in the ischemic myocardium [5]. Nevertheless, not all patients with symptomatic CHF have high NT-pro-BNP plasma concentrations, and not all asymptomatic patients have low NT-pro-BNP values. Furthermore, plasma NT-pro-BNP provides prognostic information in patients
%U http://www.hindawi.com/journals/dm/2013/687467/