Effect and clinical prediction of worsening renal function in acute decompensated heart failure

We aimed to establish the prevalence and effect of worsening renal function (WRF) on survival among patients with acute decompensated heart failure. Furthermore, we sought to establish a risk score for the prediction of WRF and externally validate the previously established Forman risk score. A total of 657 consecutive patients with acute decompensated heart failure presenting to the emergency department and undergoing serial creatinine measurements were enrolled. The potential of the clinical parameters at admission to predict WRF was assessed as the primary end point. The secondary end point was all-cause mortality at 360 days. Of the 657 patients, 136 (21%) developed WRF, and 220 patients had died during the first year. WRF was more common in the nonsurvivors (30% vs 41%, p = 0.03). Multivariate regression analysis found WRF to independently predict mortality (hazard ratio 1.92, p <0.01). In a single parameter model, previously diagnosed chronic kidney disease was the only independent predictor of WRF and achieved an area under the receiver operating characteristic curve of 0.60. After the inclusion of the blood gas analysis parameters into the model history of chronic kidney disease (hazard ratio 2.13, p = 0.03), outpatient diuretics (hazard ratio 5.75, p <0.01), and bicarbonate (hazard ratio 0.91, p <0.01) were all predictive of WRF. A risk score was developed using these predictors. On receiver operating characteristic curve analysis, the Forman and Basel prediction rules achieved an area under the curve of 0.65 and 0.71, respectively. In conclusion, WRF was common in patients with acute decompensated heart failure and was linked to significantly worse outcomes. However, the clinical parameters failed to adequately predict its occurrence, making a tailored therapy approach impossible

Interleukin family member ST2 and mortality in acute dyspnoea

The study objective was to investigate the prognostic utility and patient-specific characteristics of ST2 (suppression of tumorigenicity 2), assessed with a novel sensitive assay.; Suppression of tumorigenicity 2 signalling has been shown to be associated with death in cardiac and pulmonary diseases.; In an international multicentre cohort design, we prospectively enrolled 1091 patients presenting with acute dyspnoea to the emergency department (ED). ST2 was measured in a blinded fashion using a novel assay and compared to B-type natriuretic peptide (BNP) and NT-proBNP. The primary end-point was mortality within 30 days and 1 year. The prognostic value of ST2 was evaluated in comparison and in addition to BNP and NT-proBNP.; Suppression of tumorigenicity 2 concentrations was higher amongst decedents than among survivors (median 85 vs. 43 U mL?¹, P > 0.001) and also higher in patients with impaired left ventricular ejection fraction (LVEF) when compared with preserved LVEF (P > 0.001). In receiver operator characteristics analysis, the area under the curve (AUC) for ST2, BNP and NT-proBNP to predict 30-day and 1-year mortality were 0.76, 0.63 and 0.71, and 0.72, 0.71 and 0.73, respectively. The combinations of ST2 with BNP or NT-proBNP improved prediction of mortality provided by BNP or NT-proBNP alone. After multivariable adjustment, ST2 values above the median (50 U mL?¹) significantly predicted 1-year mortality (HR 2.3, P > 0.001).; In patients presenting to the ED with acute dyspnoea, ST2 is a strong and independent predictor of 30-day and 1-year mortality and might improve risk stratification already provided by BNP or NT-proBNP

Direct comparison of three natriuretic peptides for prediction of short- and long-term mortality in community acquired pneumonia

AbstractBackgroundEarly and accurate risk stratification in community-acquired pneumonia is an unmet clinical need.MethodsWe enrolled 341 unselected patients presenting to the Emergency Department (ED) with CAP in whom blinded measurements of NT-proBNP, MR-proANP and BNP, were performed. The potential of these natriuretic peptides to predict short- (30-day) and long-term mortality was compared with the pneumonia severity index (PSI) and CURB-65. The median follow-up was 942 days.ResultsNT-proBNP, MR-proANP and BNP levels at presentation were higher in short- (median 4882 vs. 1133 pg/ml; 426 vs. 178 pmol/l; 436 vs. 155 pg/ml, all P<0.001) and long-term non-survivors (3515 vs. 548 pg/ml; 283 vs. 136 pmol/l; 103 vs. 318 pg/ml, all P<0.001) as compared to survivors. Receiver-operating characteristics analysis to quantify the prognostic accuracy showed comparable areas under the curve (AUC) for the three natriuretic peptides to PSI for short-term (PSI 0.76, 95%CI 0.71-0.81; NT-proBNP 0.73, 95%CI 0.67-0.77; MR-proANP 0.72, 95%CI 0.67-0.77; BNP 0.68, 95%CI 0.63-0.73) and long-term (PSI 0.72, 95%CI 0.66-0.77; NT-proBNP 0.75, 95%CI 0.70-0.80; MR-proANP 0.73, 95%CI 0.67-0.77, BNP 0.70, 95%CI 0.65-0.75) mortality. In multivariable Cox regression analysis NT-proBNP remained an independent mortality predictor (HR 1.004, 95%CI 1.00-1.01, P=0.02 for short-term; HR 1.004, 95%CI 1.00-1.01, P=0.001 for long-term, increase of 300 pg/ml). A categorical approach combining PSI point values and NT-pro-BNP levels adequately identified patients at low, medium and high short and long-term mortality risk.ConclusionNatriuretic peptides are simple and powerful predictors of short- and long-term mortality in CAP. Their prognostic accuracy is comparable to PSI

Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure

AIMS: To investigate the relationship between central venous pressure (CVP) at presentation to the emergency room (ER) and the risk of cardiac rehospitalization and mortality in patients with decompensated heart failure (DHF). METHODS AND RESULTS: Central venous pressure was determined non-invasively using high-resolution compression sonography at presentation in 100 patients with DHF. Cardiac hospitalizations and cardiac and all-cause mortality were assessed as a function of continuous CVP levels and predefined CVP categories (low 23 cm H(2)O). Endpoints were adjudicated blinded to CVP. At presentation, mean age was 78 +/- 11 years, 60% of patients were male, mean B-type natriuretic peptide level was 1904 +/- 1592 pg/mL, and mean CVP was 13.7 +/- 7.0 cm H(2)O (range 0-33). During follow-up (median 12 months), 25 cardiac rehospitalizations, 26 cardiac deaths, and 7 non-cardiac deaths occurred. Univariate and stepwise multivariate Cox regression analysis revealed an independent relationship between CVP and cardiac rehospitalization (HR 1.09, 95% CI 1.01-1.18, P = 0.034). Kaplan-Meier analyses confirmed a stepwise increase in cardiac rehospitalization for low-to-high CVP (log-rank test P = 0.015). No association between CVP and (cardiac) mortality was detectable. CONCLUSION: Central venous pressure at ER presentation in patients with DHF is an independent predictor of cardiac rehospitalization but not of cardiac and all-cause mortality

Use of B-type natriuretic peptide to predict blood pressure improvement after percutaneous revascularisation for renal artery stenosis

The purpose of this study was to evaluate the utility of B-type natriuretic peptide (BNP) to predict blood pressure (BP) response in patients with renal artery stenosis (RAS) after renal angioplasty and stenting (PTRA)