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Utility of Amino-Terminal Pro–Brain Natriuretic Peptide Testing for Prediction of 1-Year Mortality in Patients With Dyspnea Treated in the Emergency Department
James L. Januzzi, Jr, MD;
Rahul Sakhuja, MD, MPP;
Michelle O’Donoghue, MD;
Aaron L. Baggish, MD;
Saif Anwaruddin, MD;
Claudia U. Chae, MD, MPH;
Renee Cameron, MS;
Daniel G. Krauser, MD;
Roderick Tung, MD;
Carlos A. Camargo, Jr, MD, DrPH;
Donald M. Lloyd-Jones, MD, ScM
Arch Intern Med. 2006;166:315-320.
Background Amino-terminal pro–brain natriuretic peptide (NT-proBNP) is useful for diagnosis and triage of patients with dyspnea, but its role for predicting outcomes in such patients remains undefined.
Methods A total of 599 breathless patients treated in the emergency department were prospectively enrolled, and a sample of blood was obtained for NT-proBNP measurements. After 1 year, the vital status of each patient was ascertained, and the association between NT-proBNP values at presentation and mortality was assessed.
Results At 1 year, 91 patients (15.2%) had died. Median NT-proBNP concentrations at presentation among decedents were significantly higher than those of survivors (3277 vs 299 pg/mL; P<.001). The optimal NT-proBNP cut point for predicting 1-year mortality was 986 pg/mL. In a multivariable model, an NT-proBNP concentration greater than 986 pg/mL at presentation was the single strongest predictor of death at 1 year (hazard ratio [HR], 2.88; 95% confidence interval, 1.64-5.06; P<.001), independent of a diagnosis of heart failure. Other factors associated with death included age (by decade; HR, 1.20), heart rate (by decile; HR, 1.13), urea nitrogen level (by decile; HR, 1.20), systolic blood pressure less than 100 mm Hg (HR, 1.94), heart murmur (HR, 1.92), and New York Heart Association classification (HR, 1.38 for each increase in class). The NT-proBNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0.76 for predicting mortality; the other significant covariates combined had an AUC of 0.80. The final model for predicting death, combining NT-proBNP with other covariates associated with mortality, had a superior AUC of 0.82.
Conclusion In addition to assisting in emergency department diagnosis and triage, NT-proBNP concentrations at presentation are strongly predictive of 1-year mortality in dyspneic patients.
Author Affiliations: Departments of Internal Medicine (Drs Januzzi, Sakhuja, O’Donoghue, Baggish, Anwaruddin, Chae, Krauser, Tung, and Camargo and Ms Cameron) and Emergency Medicine (Dr Camargo), Massachusetts General Hospital and Harvard Medical School, Boston; and Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill (Dr Lloyd-Jones).
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