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BNP Level Predicts Mortality in Acute Decompensated Heart Failure

The association is linear and independent of left ventricular ejection fraction.

The Acute Decompensated Heart Failure National Registry is a prospective database of patient information beginning with the initial point of care, either in the hospital or emergency department, and continuing until patient discharge, transfer, or death. Researchers retrospectively evaluated this data to determine if admission B-type natriuretic peptide (BNP) level predicted in-hospital mortality in patients with acute decompensated heart failure.

The 48,629 BNP measurements obtained within 24 hours of presentation were divided into quartiles: Q1 (<430 pg/mL), Q2 (430–839 pg/mL), Q3 (840–1729 pg/mL), and Q4 (1730 pg/mL). Mortality rate increased linearly with increasing BNP level. Depending on adjustments made in the analyses, the odds ratio for death was 2.23 to 3.17 times higher in patients with admission BNP levels in Q4 as compared to Q1. The association between mortality and BNP level persisted independent of left ventricular ejection fraction (LVEF), new-onset acute heart failure, or acute decompensation of chronic heart failure. BNP levels also predicted need for mechanical ventilation, length of hospital stay, intensive care unit admission, need for cardiopulmonary resuscitation requirements, and symptoms at discharge.

Comment: These authors demonstrate that BNP level is an effective risk-assessment tool for mortality and multiple complications arising from acute decompensated heart failure. The biomarker predicted morbidity and mortality even in patients with LVEF <15%, who would be expected to have chronically elevated BNP. In addition, higher BNP was associated with lower LVEF. Further research may lead us to use BNP as the "troponin of heart failure," with elevated levels portending a worse prognosis, regardless of other clinical findings. This study provides helpful information in an area that currently has little evidence-based direction regarding patient management.

— Tiffany M. Osborn, MD

Published in Journal Watch Emergency Medicine June 1, 2007

Citation(s):

Fonarow GC et al. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol 2007 May 15; 49:1943-50.

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