The Utilization and Prognostic Impact of B-type Natriuretic Peptide among Hospitalized Acute Heart Failure

• Main Authors: Li-Juen Chen, 陳莉娟
• Other Authors: Mei-Jy Jeng
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/30307741619690803831

碩士 === 國立陽明大學 === 急重症醫學研究所 === 104 === Background: B-type natriuretic peptide (BNP) levels during admission have been shown to have prognostic value in the diagnosis of heart failure and further predict the in-hospital mortality of acute heart failure (AHF). This study describes the characteristics of BNP among hospitalized AHF and elucidates its prognostic value of in-hospital mortality in Taiwan. Methods: We consecutively studied patients aged 20+ who were discharged with a diagnosis of acute heart failure from March , year of 102 ( official calendar in Taiwan) to March , year of 103 ( official calendar in Taiwan) in a teaching hospital by reviewing medical records. Prognostic predictors of mortality were assessed using Cox proportional hazard regression models. BNP > 100 pg/ml was used as the cut-off for defining abnormally high BNP based on current clinical practice criteria. Results: After implementation of our exclusion criteria, a total of 1,807 patients hospitalized with acute heart failure were studied. Compared to those subjects with BNP <100 pg/ml, individuals with higher BNP tended to have more advanced age, more clusters of the typical signs of heart failure (HF) at presentation, lower ejection fraction, lower hemoglobin levels, more disturbed biochemical data, worsened renal function, and twice the risk for in-hospital mortality (15.2 % vs 6.2 %, all p < 0.05). In a multivariate analysis, more advanced age, the presence of pulmonary basilar rales, a worse New York Heart Association functional class, longer QRS duration, and abnormal BNP levels (>100 pg/ml) were all associated with in-hospital mortality among admitted HF patients after accounting for initial admission presentations and left ventricular ejection fraction (HR: 2.17, 95 % CI: 1.15 – 6.64, p = 0.024). Conclusion: Abnormally high BNP levels in acute heart failure patients during admission of emergency department were associated to clinical presentations of worse physical, functional, and clinical presentations, and further provided prognostic value for determining in-hospital mortality among patients hospitalized with acute heart failure in Taiwan.