Discharge BNP is a stronger predictor of 6-month mortality in acute heart failure compared with baseline BNP and admission-to-discharge percentage BNP reduction

Introduction: Prior studies found a significant relationship between admission B-type natriuretic peptide (BNP), discharge BNP and admission-to-discharge percentage BNP reduction and post-discharge mortality in acute heart failure (HF). Methods: The ESCAPE trial data was utilized to identify which of these BNP parameters best predicts 6-month all-cause mortality. Results: 433 patients (mean age 56 years, 74% men) included in our analysis had an admission BNP, discharge BNP and admission-to-discharge percentage BNP reduction of 1009 pg/mL, 743 pg/mL and -70%, respectively. There were significant differences between survivors and nonsurvivors with regards to admission BNP (P = 0.001), discharge BNP (P = 0.0001) and admission-to-discharge percentage BNP reduction (P = 0.01). Discharge BNP had the highest area under the curve (AUC) for predicting mortality (AUC = 0.702, P < 0.001) followed by admission BNP (AUC = 0.633, P = 0.0006) then percentage BNP reduction (AUC = 0.620, P = 0.008). Comparison of AUC revealed a significant difference between discharge BNP and admission BNP (difference between areas 0.087, P = 0.0223) and a trend towards significance when comparing AUC of discharge BNP with percentage BNP reduction (P = 0.0637). Kaplan-Meier analysis showed a significant difference in survival according to optimum cutoff values of discharge BNP of 319 pg/mL (log-rank P < 0.001), admission BNP of 912 pg/mL (P < 0.001) and percentage BNP reduction of 7.71% (P = 0.008). Cox-proportional-hazard-analysis revealed that discharge BNP is an independent predictor of 6-month mortality (hazard ratio = 1.063, 95% CI = 1.037-1.089, P < 0.001). The combination of a discharge BNP = 319 pg/mL and percentage BNP reduction = 7.71% was associated with significantly lower mortality (4.8% versus 27.2%, relative risk = 0.134, 95% CI = 0.046-0.387, P < 0.001). Conclusion: The absolute BNP value at discharge is a more accurate predictor of 6-month mortality than the magnitude of percentage in-hospital BNP reduction and baseline BNP. (C) 2016 Elsevier Ireland Ltd. All rights reserved.