全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

Predictive Value of Admission N-Terminal Pro-B-Type Natriuretic Peptide and Renal Function in Older People Hospitalized for Dyspnoea

DOI: 10.1155/2013/687467

Full-Text   Cite this paper   Add to My Lib

Abstract:

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: 0.950–0.988; ) and 2.360 (95% confidence interval: 1.208–4.610; ), respectively. Patients characterized by high NT-pro-BNP levels and GFR ≥ 60?mL/min/1.73?m2 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 60?mL/min/1.73?m2 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, 47–77, 77–133, 133–241, and >241?pg/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

References

[1]  A. J. de Bold, B. G. Bruneau, and M. L. K. de Bold, “Mechanical and neuroendocrine regulation of the endocrine heart,” Cardiovascular Research, vol. 31, no. 1, pp. 7–18, 1996.
[2]  I. Oudejans, A. Mosterd, N. P. A. Zuithoff, and A. W. Hoes, “Applicability of current diagnostic algorithms in geriatric patients suspected of new, slow onset heart failure,” Age and Ageing, vol. 41, no. 3, Article ID afr181, pp. 309–316, 2012.
[3]  A. Hozawa, Y. Sugawara, Y. Tomata et al., “Relationships between n-terminal pro b-type natriuretic peptide and incident disability and mortality in older community-dwelling adults: the Tsurugaya study,” Journal of the American Geriatrics Society, vol. 58, no. 12, pp. 2439–2441, 2010.
[4]  P. Kleczyński, J. Legutko, T. Rakowski et al., “Predictive utility of NT-pro BNP for infarct size and left ventricle function after acute myocardial infarction in long-term follow-up,” Disease Markers, vol. 34, no. 3, pp. 199–204, 2013.
[5]  A. Surdacki, E. Marewicz, T. Rakowski et al., “Coincidence of moderately elevated N-terminal pro-B-type natriuretic peptide, endothelial progenitor cells deficiency and propensity to exercise-induced myocardial ischemia in stable angina,” Disease Markers, vol. 28, no. 2, pp. 101–114, 2010.
[6]  A. Gegenhuber, T. Mueller, B. Dieplinger, W. Poelz, R. Pacher, and M. Haltmayer, “B-type natriuretic peptide and amino terminal proBNP predict one-year mortality in short of breath patients independently of the baseline diagnosis of acute destabilized heart failure,” Clinica Chimica Acta, vol. 370, no. 1-2, pp. 174–179, 2006.
[7]  F. Fabbian, A. de Giorgi, M. Pala, R. Tiseo, and F. Portaluppi, “Elevated NT-proBNP levels should be interpreted in elderly patients presenting with dyspnea,” European Journal of Internal Medicine, vol. 22, no. 1, pp. 108–111, 2011.
[8]  B. Vaes, W. de Ruijter, J. Gussekloo, and J. Degryse, “The accuracy of plasma natriuretic peptide levels for diagnosis of cardiac dysfunction and chronic heart failure in community-dwelling elderly: a systematic review,” Age and Ageing, vol. 38, no. 6, pp. 655–662, 2009.
[9]  K. Dickstein, A. Cohen-Solal, G. Filippatos et al., “ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008,” European Heart Journal, vol. 29, pp. 2388–2442, 2008.
[10]  C. Stenton, “The MRC breathlessness scale,” Occupational Medicine, vol. 58, no. 3, pp. 226–227, 2008.
[11]  A. S. Levey, L. A. Stevens, C. H. Schmid et al., “A new equation to estimate glomerular filtration rate,” Annals of Internal Medicine, vol. 150, no. 9, pp. 604–612, 2009.
[12]  National Kidney Foundation, “K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification,” American Journal of Kidney Diseases, vol. 36, supplement 1, pp. S1–S266, 2002.
[13]  J. L. Januzzi Jr., “Natriuretic peptide testing: a window into the diagnosis and prognosis of heart failure,” Cleveland Clinic Journal of Medicine, vol. 73, no. 2, pp. 149–157, 2006.
[14]  R. Pfister, D. Tan, J. Thekkanal, M. Hellmich, E. Erdmann, and C. A. Schneider, “NT-pro-BNP measured at discharge predicts outcome in multimorbid diabetic inpatients with a broad spectrum of cardiovascular disease,” Acta Diabetologica, vol. 44, no. 2, pp. 91–97, 2007.
[15]  M. Christ, A. Thuerlimann, K. Laule et al., “Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoea,” European Journal of Clinical Investigation, vol. 37, no. 11, pp. 834–841, 2007.
[16]  B. Stanek, B. Frey, M. Hülsmann et al., “Prognostic evaluation of neurohumoral plasma levels before and during beta-blocker therapy in advanced left ventricular dysfunction,” Journal of the American College of Cardiology, vol. 38, no. 2, pp. 436–442, 2001.
[17]  J. Koglin, S. Pehlivanli, M. Schwaiblmair, M. Vogeser, P. Cremer, and W. VonScheidt, “Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure,” Journal of the American College of Cardiology, vol. 38, no. 7, pp. 1934–1941, 2001.
[18]  R. Berger, M. Huelsman, K. Strecker et al., “B-type natriuretic peptide predicts sudden death in patients with chronic heart failure,” Circulation, vol. 105, no. 20, pp. 2392–2397, 2002.
[19]  I. Idris, R. Hill, I. Ross, and J. C. Sharma, “N-terminal probrain natriuretic peptide predicts 1-year mortality following acute stroke: possible evidence of occult cardiac dysfunction among patients with acute stroke,” Age and Ageing, vol. 39, no. 6, Article ID afq098, pp. 752–755, 2010.
[20]  J. A. Doust, E. Pietrzak, A. Dobson, and P. P. Glasziou, “How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review,” British Medical Journal, vol. 330, no. 7492, pp. 625–627, 2005.
[21]  A. Gegenhuber, T. Mueller, B. Dieplinger, W. Poelz, R. Pacher, and M. Haltmayer, “B-type natriuretic peptide and amino terminal proBNP predict one-year mortality in short of breath patients independently of the baseline diagnosis of acute destabilized heart failure,” Clinica Chimica Acta, vol. 370, no. 1-2, pp. 174–179, 2006.
[22]  U. Alehagen and U. Dahlstr?m, “Can NT-proBNP predict risk of cardiovascular mortality within 10 years? Results from an epidemiological study of elderly patients with symptoms of heart failure,” International Journal of Cardiology, vol. 133, no. 2, pp. 233–240, 2009.
[23]  S. G. Wannamethee, P. Welsh, G. D. Lowe et al., “N-terminal pro-brain natriuretic peptide is a more useful predictor of cardiovascular disease risk than C-reactive protein in older men with and without pre-existing cardiovascular disease,” Journal of the American College of Cardiology, vol. 58, no. 1, pp. 56–64, 2011.
[24]  J.-L. Reny, O. Millot, T. Vanderecamer et al., “Admission NT-proBNP levels, renal insufficiency and age as predictors of mortality in elderly patients hospitalized for acute dyspnea,” European Journal of Internal Medicine, vol. 20, no. 1, pp. 14–19, 2009.
[25]  M. Svensson, A. Gorst-Rasmussen, E. B. Schmidt, K. A. Jorgensen, and J. H. Christensen, “NT-pro-BNP is an independent predictor of mortality in patients with end-stage renal disease,” Clinical Nephrology, vol. 71, no. 4, pp. 380–386, 2009.
[26]  J. E. Lee, S. Y. Choi, W. Huh et al., “N-terminal pro-brain natriuretic peptide levels predict left ventricular systolic function in patients with chronic kidney disease,” Journal of Korean Medical Science, vol. 24, supplement 1, pp. S63–68, 2009.
[27]  F. Fabbian, M. Pala, and R. Manfredini, “Intensive therapy and GFR in type 1 diabetes,” The New England Journal of Medicine, vol. 366, no. 9, pp. 856–857, 2012.
[28]  K. Alagiakrishman and A. Senthilselvan, “Comparison of chronic kidney disease (CKD) epidemiology formula with other calculated creatinine formulas for the determination of CKD in cognitively intact and impaired elderly outpatients,” Journal of the American Geriatrics Society, vol. 60, no. 6, pp. 1181–1183, 2012.
[29]  A. Earley, D. Miskulin, E. J. Lamb, A. S. Levey, and K. Uhlig, “Estimating equations for glomerular filtration rate in the era of creatinine standardization. A systematic review.,” Annals of Internal Medicine, vol. 156, no. 11, pp. 785–795, 2012.
[30]  A. Corsonello, C. Pedone, F. Lattanzio, G. Onder, and R. Antonelli Incalzi, “Association between glomerular filtration rate and adverse drug reactions in elderly hospitalized patients: the role of the estimating equation,” Drugs and Aging, vol. 28, no. 5, pp. 379–390, 2011.
[31]  F. Fabbian, A. de Giorgi, F. Portaluppi, and G. Zuliani, “Relationship between N-terminal pro-B-type natriuretic peptide plasma levels and renal function evaluated with different formulae in older adult subjects admitted because of dyspnea,” Gerontology, vol. 58, no. 1, pp. 50–55, 2011.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133