Summary

Prognostic value of emergency department testing for N-terminal fragment of brain natriuretic peptide in patients with acute heart failure: the PICASU-1 study

Jacob J, Llorens Soriano P, Martín-Sánchez FJ, Herrero Puente P, Álvarez Argüelles A, Pérez-Durá MJ, Noval De La Torre A, Segura F, Richard Espiga F, Giménez Valverde A, Miró O

Affiliation of the authors

Servicio de Urgencias. Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat. Barcelona, Spain. Servicio de Urgencias-UCE y UHD. Hospital General Universitario de Alicante. Alicante, Spain. Servicio de Urgencias-UCE. Hospital Clínico San Carlos de

DOI

Quote

Jacob J, Llorens Soriano P, Martín-Sánchez FJ, Herrero Puente P, Álvarez Argüelles A, Pérez-Durá MJ, et al. Prognostic value of emergency department testing for N-terminal fragment of brain natriuretic peptide in patients with acute heart failure: the PICASU-1 study. Emergencias. 2011;23:183-92

Summary

Objective: To determine the usefulness of hospital emergency department testing for

the N-terminal fragment of brain natriuretic peptide (NT-proBNP) as a predictor of

mortality and revisits in patients with acute heart failure (AHF).

Methods: The PICASU-1 study (NT-proBNP in AHF in the Emergency Department) was an

analytical multicenter cohort study that included 641 patients with AHF attended at 9

emergency departments that were able to perform emergency NT-proBNP tests. Data

collected included 18 variables related to the patient’s baseline situation and 21 variables

related to the episode of AHF. The area under the receiver operating characteristic curves

(AUC) were calculated to assess the ability of NT-proBNP level to predict in-hospital mortality,

30-day mortality, and revisiting. Ninety-day survival curves were also constructed.

Results: Elevated NT-proBNP concentrations were found in patients who died in hospital

and within 30 days of emergency care (P<.001, both cases). No differences were seen between patients who revisited within 30 days and those who did not (P=.91). The 90- day survival curves gave similar results. NT-proBNP concentration had a moderate ability to predict mortality in-hospital (AUC, 0.75; P<.001) and within 30 days (AUC, 0.71; P<.001), but no predictive power for revisiting (AUC, 0.50; P=.92). These results were consistent with those for the 244 patients who were discharged home from the emergency department (38.3%): the NT-proBNP levels were higher for those who died within 30 days (P<.01) but similar for revisiting and nonrevisiting patients (P=.50). In these patients, NT-proBNP level once again had moderate predictive power for 30-day mortality (AUC, 0.72; P<.01) but no association with revisiting (AUC, 0.47; P=.50). Conclusion: NT-proBNP testing seems useful for predicting the likelihood of death for a particular patient with AHF, but it has no ability to predict ED revisiting.

 

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