NT-probnp Variability as a Predictor of Adverse Outcomes in Patients With Cardiorenal Syndrome Type 2 [post]

Mingming Ma, Xiangnan Dong, Shuang Cui, Berthold Hocher, Shufei Zeng, Wenxue Liang, Qiang Li, Xiaoyi Chen, Xin Chen, Yu Meng, Yongping Lu, Lianghong Yin
2020 unpublished
Background: N-terminal prohormone B-type natriuretic peptide (NT-proBNP) is a significant predictor of cardiovascular and all-cause mortality in patients with chronic heart failure (HF) without chronic kidney disease (CKD). However, it is unknown whether variability of NT-proBNP is predictive of the outcomes of those with advanced HF and CKD.Methods: Intra-individual fluctuations in NT-proBNP values from baseline to follow-up were determined to assess the prognostic value of NT-proBNP
more » ... NT-proBNP variability in patients with cardiorenal syndrome (CRS) type 2 in a retrospective cohort of 136 patients treated for advanced HF with CKD at the First Affiliated Hospital of Jinan University from 2012 to 2016. Patients hospitalized for CRS type 2 who underwent follow-up examinations were eligible for study inclusion and grouped according to optimal cutoff values of receiver operating characteristic (ROC) curve analysis of log10(NT-proBNP) variability. The primary outcomes were major adverse renal and cardiac events( a composite of acute kidney disease, nonfatal myocardial infarction, cardiac death ,stroke or maintenance hemodialysis). Secondary outcomes were repeated hospitalization for heart failure or all cause death.Results: The results showed that higher NT-proBNP variability group was associated with lower hemoglobin(p < 0.01) and plasma serum albumin levels(p < 0.02) , and greater decline in left ventricular ejection fraction(p < 0.02 ) compared with the lower NT-proBNP variability group. At a median follow-up of 22 (interquartile range, 5–32) months, Individuals in the higher NT-proBNP variability group was associated with a greater risk of major adverse renal and cardiac events (HR = 3.467, 95% CI =1.463–8.215, p = 0.01). ROC analysis revealed that NT-proBNP variability rather than average NT-proBNP level, was a better predictive biomarker of the primary outcomes (AUC = 0.726,95% CI = 0.640–0.812) and secondary outcomes(AUC = 0.701,95% CI = 0.611–0.791). Kaplan-Meier analysis showed that NT-proBNP variability of ≥0.272 was significantly correlated with a higher prevalence of primary and secondary outcomes (p < 0.03). This correlation remained significant in multivariate Cox regression models after adjustments for age, anemia, and traditional risk factors. Conclusions: NT-proBNP variability might serve as an independent predictor for major adverse renal and cardiac events and all-cause death in patients with CRS type 2.
doi:10.21203/rs.3.rs-106286/v1 fatcat:n37d5v3jafa7li24t24dhytd6a