P3465 Comparison of N terminal pro-brain natriuretic peptide and urine albumin levels in the prediction of all cause mortality in the general population

Background Neurological prognosis after cardiac arrest remains ill-defined. Plasma brain natriuretic peptide (BNP) may relate to poor neurological prognosis in brain-injury patients, though it has not been well studied in survivors of cardiac arrest. Methods We performed a retrospective review and examined the association of BNP with mortality and neurological outcomes at discharge in a cohort of cardiac arrest survivors enrolled from January 2012 to December 2016 at the Wake Forest Baptist Hospital, in North Carolina. Cerebral performance category (CPC) and modified Rankin scales were calculated from the chart based on neurological evaluation performed at the time of discharge. The cohort was subdivided into quartiles based on their BNP levels after which multivariable adjusted logistic regression models were applied to assess for an association between BNP and poor neurological outcomes as defined by a CPC of 3 to 4 and a modified Rankin scale of 4 to 5. Results Of the 657 patients included in the study, 254 patients survived until discharge. Among these, poor neurological status was observed in 101 (39.8%) patients that had a CPC score of 3 to 4 and 97 patients (38.2%) that had a modified Rankin scale of 4 to 5. Mean BNP levels were higher in patients with poor neurological status compared to those with good neurological status at discharge ( P = .03 for CPC 3-4 and P = .02 for modified Rankin score 4-5). BNP levels however, did not vary significantly between patients that survived and those that expired ( P = .22). BNP did emerge as a significant discriminator between patients with severe neurological disability at discharge when compared to those without. The area under the curve for BNP predicting a modified Rankin score of 4 to 5 was 0.800 (95% confidence interval [CI] 0.756-0.844, P < .001) and for predicting CPC 3 to 4 was 0.797 (95% CI 0.756-0.838, P < .001). BNP was able to significantly improve the net reclassification index and integrated discriminatory increment ( P < .05). BNP was not associated with long-term all-cause mortality ( P > .05). Conclusions In survivors of either inpatient or out-of-hospital cardiac arrest, increased BNP levels measured at the time of arrest predicted severe neurological disability at discharge. We did not observe an independent association between BNP levels and long-term all-cause mortality. BNP may be a useful biomarker for predicting adverse neurological outcomes in survivors of cardiac arrest.

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52 Brain natriuretic peptide predicts all cause mortality in patients with type 2 diabetes and normal ejection fractions

Heart ◽

10.1136/heartjnl-2011-300198.52 ◽

2011 ◽

Vol 97 (Suppl 1) ◽

pp. A34-A34

Author(s):

B. R. Szwejkowski ◽

D. H. J. Elder ◽

A. Dawson ◽

A. D. Struthers

Keyword(s):

Type 2 Diabetes ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

All Cause Mortality

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N-terminal pro-brain natriuretic peptide, but not high sensitivity C-reactive protein, improves cardiovascular risk prediction in the general population

European Heart Journal ◽

10.1093/eurheartj/ehl448 ◽

2007 ◽

Vol 28 (11) ◽

pp. 1374-1381 ◽

Cited By ~ 103

Author(s):

M. H. Olsen ◽

T. W. Hansen ◽

M. K. Christensen ◽

F. Gustafsson ◽

S. Rasmussen ◽

...

Keyword(s):

Cardiovascular Risk ◽

General Population ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Risk Prediction ◽

High Sensitivity ◽

C Reactive Protein ◽

Reactive Protein ◽

Cardiovascular Risk Prediction

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The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population

Heart ◽

10.1136/heart.89.7.745 ◽

2003 ◽

Vol 89 (7) ◽

pp. 745-751 ◽

Cited By ~ 218

Author(s):

I Raymond

Keyword(s):

Plasma Level ◽

General Population ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Large Sample

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Prognostic Value of Brain Natriuretic Peptide in Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3181aaeb11 ◽

2009 ◽

Vol 111 (2) ◽

pp. 311-319 ◽

Cited By ~ 130

Author(s):

Alisdair D. S. Ryding ◽

Saurabh Kumar ◽

Angela M. Worthington ◽

David Burgess

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Cardiac Death ◽

Prognostic Value ◽

Meta Analysis ◽

Noncardiac Surgery ◽

Cardiac Mortality ◽

Short Term ◽

Increased Risk ◽

All Cause Mortality

Background The prognostic role of brain natriuretic peptide (BNP) measurement before noncardiac surgery is unclear. The authors therefore performed a meta-analysis of studies in patients undergoing noncardiac surgery to assess the prognostic value of elevated BNP or N-terminal pro-BNP (NT-proBNP) levels in predicting mortality and major adverse cardiovascular events (MACE) (cardiac death or nonfatal myocardial infarction). Methods Unrestricted searches of MEDLINE and EMBASE bibliographic databases were performed using the terms "brain natriuretic peptide," "b-type natriuretic peptide," "BNP," "NT-proBNP," and "surgery." In addition, review articles, bibliographies, and abstracts of scientific meetings were manually searched. The meta-analysis included prospective studies that reported on the association of BNP or NT-proBNP and postoperative major adverse cardiovascular event (MACE) or mortality. The study endpoints were MACE, all-cause mortality, and cardiac mortality at short-term (less than 43 days after surgery) and longer-term (more than 6 months) follow-up. A random-effects model was used to pool study results; funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square test and I testing was used to test for heterogeneity. Results Data from 15 publications (4,856 patients) were included in the analysis. Preoperative BNP elevation was associated with an increased risk of short-term MACE (OR 19.77; 95% confidence interval [CI] 13.18-29.65; P < 0.0001), all-cause mortality (OR 9.28; 95% CI 3.51-24.56; P < 0.0001), and cardiac death (OR 23.88; 95% CI 9.43-60.43; P < 0.00001). Results were consistent for both BNP and NT-proBNP. Preoperative BNP elevation was also associated with an increased risk of long-term MACE (OR 17.70; 95% CI 3.11-100.80; P < 0.0001) and all-cause mortality (OR 4.77; 95% CI 2.99-7.46; P < 0.00001). Conclusions Elevated BNP and NT-proBNP levels identify patients undergoing major noncardiac surgery at high risk of cardiac mortality, all-cause mortality, and MACE.

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Pre- and Post-Transcatheter Aortic Valve Replacement Serum Brain Natriuretic Peptide Levels and All-Cause Mortality

Cardiology ◽

10.1159/000509857 ◽

2020 ◽

Vol 145 (12) ◽

pp. 813-821

Author(s):

Gabby Elbaz-Greener ◽

Diab Ghanim ◽

Fabio Kusniec ◽

Asaf Rabin ◽

Doron Sudarsky ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Risk Stratification ◽

Brain Natriuretic Peptide ◽

Valve Replacement ◽

Natriuretic Peptide ◽

Transcatheter Aortic Valve Replacement ◽

Study Cohort ◽

Transcatheter Aortic Valve ◽

All Cause Mortality

Background: Risk stratification in patients post-transcatheter aortic valve replacement (TAVR) is limited to and is based on clinical judgment and surgical scoring systems. Serum natriuretic peptides are used for general risk stratification in patients with aortic stenosis, reflecting the increase in their afterload and thereby stressing the need for valve intervention. The objective of this study was to determine the predictive value of pre- and post-procedural serum brain natriuretic peptide (BNP) on 1-year all-cause mortality in patients who underwent TAVR. Methods: In this population-based study, we included 148 TAVR patients treated at the Poriya Medical Center between June 1, 2015, and May 31, 2018. Routine blood samples for serum BNP levels (pg/mL) were taken just before the TAVR and 24 h post-TAVR. Our primary clinical outcome was defined as 1-year all-cause mortality. We used backward regression models and included all variables that had a p value <0.1 in the univariable analysis. A receiver-operating characteristic curve was calculated for the prediction of all-cause mortality by serum BNP levels using the median as the cut-off point. Results: In this study cohort, BNP levels 24 h post-TAVR higher than the cohort median versus lower than the cohort median (387.5 pg/mL; IQR 195–817.6) were the strongest predictor of 1-year mortality (hazard ratio 9; 95% CI 2.72–30.16; p < 0.001). The statistically significant relationship was seen in the unadjusted regression model as well as after the adjustment for clinical variables. Conclusions: Serum BNP levels 24 h post-procedure were found to be a meaningful marker in predicting 1-year all-cause mortality in patients after TAVR procedure.

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