Prognostic value of N-terminal prohormone brain natriuretic peptide for in-hospital and long-term outcomes in patients with infective endocarditis

Abstract

Background Limited research studies with a large sample size were performed to evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for in-hospital or long-term poor outcomes in patients with infective endocarditis. Methods A total of 703 patients with infective endocarditis were enrolled and divided into four groups according to admission NT-pro-BNP (pg/mL) quartiles: Q1 (<258), Q2 (258-1054), Q3 (1055-3522) and Q4 (>3522). Multivariate regression was used to determine independent risk of NT-proBNP for in-hospital and one-year death. Results In-hospital death occurred in 9.0% of patients. The in-hospital mortality was increased from the lowest to the highest NT-proBNP quartiles (1.1%, 3.4%, 9.1% and 22.3%, P < 0.001, respectively). During the one-year follow-up period, 29 patients died: 0 in Q1, 7 (4.6%) in Q2, 8 (5.7%) in Q3 and 14 (12.0%) in Q4 ( P < 0.001). Log-transformed (lg) NT-proBNP had a linear correlation with lg C-reactive protein ( r = 0.308, P < 0.001). Multivariate analysis showed lgNT-proBNP was an independent predictor for both in-hospital (odds ratio 4.59, 95% confidence interval (CI) 2.45-8.61, P < 0.001) and one-year mortality (hazard ratio 3.11, 95% CI 1.65-5.87, P < 0.001). In addition, NT-proBNP had a higher predictive power for in-hospital death than C-reactive protein (area under the curve 0.797 vs. 0.670, P = 0.005). NT-proBNP > 2260 pg/mL had 76.2% sensitivity and 69.1% specificity for predicting in-hospital death. Kaplan-Meier analysis showed that patients with NT-proBNP > 2260 pg/ml had a worse prognosis than those without (log-rank test 18.84, P < 0.001). Conclusion Increased NT-proBNP was independently associated with in-hospital and one-year mortality in patients with infective endocarditis.

N-terminal fraction of pro-B-type natriuretic peptide versus clinical risk scores for prognostic stratification in chronic systolic heart failure

“…Finally, the performance of natriuretic peptides added to other patient variables for risk stratification deserves consideration also in disease settings other than HF, as suggested by several studies. 17–19…”

“…Finally, the performance of natriuretic peptides added to other patient variables for risk stratification deserves consideration also in disease settings other than HF, as suggested by several studies. [17][18][19] The main limitation of this preliminary, hypothesisgenerating study is the presence of two population subgroups. As all variables needed for SHFM calculation were available only for patients with more recent assessment, the SHFM score could be computed only in 39% of patients.…”

N-terminal pro-B-type natriuretic peptide and outcomes in type B aortic dissection in China: a retrospective multicentre study

“…Changes in systemic inflammatory markers, such as interleukin-6, CRP, tumour necrosis factor-a and matrix metalloproteinase-9, are associated with acute-phase reactions in aortic dissection, even when stenting has been performed 24. Inflammatory cytokines may also have direct effects on BNP transcription and translation in cardiomyocytes 25. In this analysis, we observed a trend towards a positive association between CRP and increasing NT-pro-BNP levels.…”

Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery

“…The major limitations of this study are its retrospective nature and that analyses were limited by the data available in our database. For example, data on confounders such as inflammation and pharmacological treatment were unavailable [ 33 , 42 ]. On the other hand, patients with acute endocarditis were excluded.…”