Abstract 2375: NT-proBNP Should be Used in the Definition of the “Cardio-Renal Syndrome”
Background NT-proBNP and worsening of renal function (WRF) both predict death in patients with heart failure (HF). WRF in acute HF defines the ‘Cardio-Renal Syndrome.’
Methods From three enrollment centers, 627 subjects presenting with acute HF were divided by NT-proBNP level and by changes in renal function. WRF was defined as a rise in serum creatinine ≥0.3 mg/dL during admission, improvement of renal function (IRF) as a decrease in serum creatinine ≥0.3 mg/dL. The rest were considered as having no creatinine change. The primary endpoint was 60 day mortality. NT-proBNP level was defined as higher or lower than the median value of 4647 pg/mL.
Results WRF was present in 308 (49%) of the subjects, IRF in 71 (11%), and 248 (40%) had neither. Independent predictors of death by 60 days included both WRF (OR=2.03; 95% CI=1.75– 4.62, p<0.001) or an NT-proBNP above the median (OR=2.72; 95% CI=1.9 –5.01; p<0.001), but the combination of the two was the strongest predictor of death by 60 days (OR=3.32; 95% CI=2.05– 4.76; p<0.001). Among subjects with an NT-proBNP above the median, those with WRF had the worst prognosis while those with IRF had the lowest mortality rates. Remarkably, in subjects with a NT-proBNP below the median, prognosis was not influenced by changes in renal function.
Conclusions The combination of NT-proBNP with measures of renal function is a better predictor of short-term outcome in acute HF than either parameter alone. NT-proBNP is more useful to delineate the ‘cardio-renal syndrome’ than the previous criteria of a clinical diagnosis of HF.