N-terminal pro-brain natriuretic peptide (NT–pro-BNP) and blood urea nitrogen (BUN)
predict outcomes in patients with heart failure (HF). However, it is unknown whether
NT–pro-BNP is a better prognostic marker than BUN in patients hospitalized with HF.
Chart reviews were performed on 257 consecutively hospitalized patients with HF whose
NT–pro-BNP levels were drawn at the time of admission. The ability of NT–pro-BNP and
BUN to predict the primary end point (death or readmission <30 days after discharge)
was determined. Seventy-three patients (28%) reached the primary end point. Patients
who reached the primary end point had significantly higher NT–pro-BNP and BUN levels.
On multivariate regression analysis, the predictive values of BUN and NT–pro-BNP were
very similar: the hazard ratio for NT–pro-BNP greater than the median was 1.81 (p
= 0.044), and the hazard ratio for BUN greater than the median was 1.83 (p = 0.039).
Analysis of the associations between NT–pro-BNP, BUN, and 30-day death or readmission
as end points showed that BUN is a better predictor of outcomes (hazard ratio 3.15,
p = 0.012) than NT–pro-BNP (hazard ratio 1.44, p = 0.399). In conclusion, in patients
admitted to hospitals with HF, BUN is at least an equal prognosticator of HF rehospitalization
or death as NT–pro-BNP. BUN outperforms NT–pro-BNP in predicting mortality in patients
with advanced HF. If admitting physicians are confident that the diagnosis of HF is
correct, then admission NT–pro-BNP adds little to clinical management.
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Article Info
Publication History
Accepted:
November 24,
2006
Received in revised form:
November 24,
2006
Received:
July 23,
2006
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
