Clinical utility of N-terminal pro-B-type natriuretic peptide for risk stratification of patients with acute decompensated heart failure. Derivation and validation of the ADHF/NT-proBNP risk score

被引：102

作者：

Scrutinio, Domenico ^{[1
]}

Ammirati, Enrico ^{[2
]}

Guida, Pietro ^{[1
]}

Passantino, Andrea ^{[1
]}

Raimondo, Rosa ^{[3
]}

Guida, Valentina ^{[2
]}

Braga, Simona Sarzi ^{[3
]}

Pedretti, Roberto F. E. ^{[3
]}

Lagioia, Rocco ^{[1
]}

Frigerio, Maria ^{[2
]}

Catanzaro, Raffaella ^{[1
]}

Oliva, Fabrizio ^{[2
]}

机构：

[1] S Maugeri Fdn, IRCCS, Ist Cassano Murge, Div Cardiol & Cardiac Rehabil, Bari, Italy

[2] Osped Niguarda Ca Granda, Cardiovasc Dept, Milan, Italy

[3] S Maugeri Fdn, IRCCS, Inst Tradate, Div Cardiol & Cardiac Rehabil, Varese, Italy

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2013年 / 168卷 / 03期

关键词：

Acute heart failure; N-terminal pro-B-type natriuretic peptide; Prognosis; Risk stratification; RENAL-FUNCTION; OUTCOMES; DEATH; PREDICTION; MORTALITY; RECLASSIFICATION; HOSPITALIZATION; MANAGEMENT; ADMISSION; PROGRAM;

D O I：

10.1016/j.ijcard.2013.01.005

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

引用

页码：2120 / 2126

页数：7

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