The predictive capacity and additional prognostic power of N-terminal pro-B-type natriuretic peptide in Chinese elderly with chronic heart failure

Figures & data

Table 1 Patient characteristics and their correlations with NT-proBNP values, along with their unadjusted influences on mortality

Variables	Descriptions	ra	Pb	HRc	Pd
Demographics
Age (years)e	85.0 (80.0–89.0)	0.023	0.685	1.051	0.001
Males (%)	248 (81.0)	0.028	0.625	0.867	0.600
History of smoking
Never (%)	191 (62.4)
Former (%)	98 (32.0)	0.010	0.856	0.852	0.433
Current (%)	17 (5.6)	0.090	0.116	0.932	0.868
BMI (kg/m^2)e	23.1 (20.6–25.7)	−0.178	0.002	0.954	0.077
Diseases
AMI (%)	29 (9.5)	0.220	<0.001	2.762	<0.001
NYHA class IV CHF (%)	78 (25.5)	0.334	<0.001	3.537	<0.001
Hypertension (%)	246 (80.4)	−0.063	0.271	0.759	0.251
DM (%)	136 (44.4)	−0.013	0.826	1.216	0.320
Atrial fibrillation (%)	96 (31.4)	0.208	<0.001	1.106	0.631
Metabolic syndrome (%)	126 (41.2)	0.024	0.675	1.417	0.077
Clinical presentation
HR (bpm)e	73.0 (64.8–82.3)	0.144	0.011	1.022	<0.001
MSBP (mmHg)e	131.0 (121.6–140.1)	−0.111	0.053	0.987	0.084
MDBP (mmHg)e	67.4 (62.4–73.6)	−0.054	0.346	0.977	0.038
Investigative variables
EF (%)e	57.0 (49.5–61.0)	−0.240	<0.001	0.988	0.255
IVS (mm)e	11.0 (10.0–12.0)	0.133	0.020	1.114	0.031
LVPW (mm)e	10.0 (10.0–11.0)	0.147	0.010	1.088	0.283
LVESD (mm)e	34.0 (32.0–38.3)	0.227	<0.001	1.010	0.497
LVEDD (mm)e	50.0 (46.3–54.0)	0.205	<0.001	1.010	0.491
LVMI (g/m)e	112.4 (97.0–132.2)	0.350	<0.001	1.007	0.010
LAD (mm)e	39.0 (35.0–43.0)	0.204	<0.001	1.005	0.752
RAD (mm)e	38.0 (35.0–41.8)	0.187	0.001	1.013	0.412
RVD (mm)e	36.0 (34.0–38.0)	0.122	0.034	1.008	0.724
AD (mm)e	35 (32.0–37.0)	−0.071	0.224	0.987	0.554
PD (mm)e	25.0 (23.0–26.9)	0.092	0.123	1.042	0.166
Laboratory results
NT-proBNP (pg/mL)e	1743.4 (513.5–4796.3)			1.603	<0.001
Hemoglobin (g/L)f	115.2 (22.1)	−0.314	<0.001	0.974	<0.001
Plasma albumin (g/L)f	36.6 (4.5)	−0.325	<0.001	0.850	<0.001
Glucose (mmol/L)e	5.6 (4.9–6.6)	0.054	0.342	1.100	0.007
Cholesterol (mmol/L)e	3.8 (3.2–4.3)	−0.096	0.097	0.976	0.814
Triglyceride (mmol/L)e	1.2 (0.9–1.9)	−0.047	0.413	1.129	0.138
HDL-C (mmol/L)e	1.0 (0.8–1.2)	−0.124	0.031	0.284	<0.001
LDL-C (mmol/L)e	2.1 (1.6–2.6)	−0.138	0.017	0.920	0.515
MDRD-eGFR (mL/min/1.73 m^2)f	59.7 (23.2)	−0.340	<0.001	0.986	0.001
Uric acid (mmol/L)e	389.6 (297.0–458.7)	0.231	<0.001	1.002	0.004
Sodium (mmol/L)e	140.0 (136.2–142.4)	−0.057	0.317	0.981	0.287
ALT (U/L)e	14.2 (10.1–19.8)	−0.108	0.060	1.002	0.311
N/L (100%)e	2.9 (2.0–5.0)	0.337	<0.001	1.066	<0.001
CRP (mg/dL)e	1.2 (0.3–3.9)	0.210	<0.001	1.047	0.003
Fibrinogen (g/L)e	3.7 (3.0–4.6)	0.162	0.005	1.333	<0.001

Notes:

a Correlation coefficients

b for correlations

c,d for Cox regression univariate analysis

e median (interquartile range)

f mean (standard deviation).

Abbreviations: NT-proBNP, N-terminal pro-B-type natriuretic peptide; HR, hazard ratio; BMI, body mass index; AMI, acute myocardial infarction; NYHA, New York Heart Association; CHF, chronic heart failure; DM, diabetes mellitus; HR, heart rate; MSBP, mean systolic blood pressure; MDBP, mean diastolic blood pressure; EF, ejection fraction; IVS, interventricular septum; LVPW, left ventricular posterior wall; LVESD, left ventricular end-systolic dimension; LVEDD, left ventricular end-diastolic dimension; LVMI, left ventricular mass index; LAD, left atrial diameter; RAD, right atrial diameter; RVD, right ventricular diameter; AD, aortic dimension; PD, pulmonic dimension; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MDRD-eGFR, estimated glomerular filtration rate calculated by modified Modification of Diet in Renal Disease equation; ALT, alanine transaminase; N/L, neutrophils/lymphocytes; CRP, C-reactive protein.

Table 2 Independent risk factors of mortality

Risk factorsa	Adjusted HR	95% CI	P
Age (years)	1.039	1.007–1.072	0.016
NYHA class IV CHF	1.890	1.250–2.858	0.003
Plasma albumin (g/L)	0.926	0.881–0.973	0.002
N/L (100%)	1.039	1.007–1.073	0.016
NT-proBNP (pg/mL)	1.282	1.103–1.489	0.001

Notes:

a Cox regression multivariate model with adjustment of all the factors.

Abbreviations: HR, hazard ratio; CI, confidence interval; NYHA, New York Heart Association; CHF, chronic heart failure; N/L, neutrophils/lymphocytes; NT-proBNP, N-terminal pro-B-type natriuretic peptide.

Figure 1 Kaplan–Meier estimate of survival for all subjects according to the quartile of NT-proBNP values.

Abbreviation: NT-proBNP, N-terminal pro-B-type natriuretic peptide.

Table 3 Prognostic abilities of NT-proBNP values and model based on NT-proBNP values compared with the SHFS

	c-Statistic (95% CI)	Z	P
NT-proBNP	0.736 (0.683–0.785)
SHFS	0.796 (0.746–0.840)	1.620	0.105a
SHFS + NT-proBNP	0.818 (0.770–0.860)	1.377	0.168b
Model based on NT-proBNP	0.846 (0.801–0.885)	1.836	0.066c

Notes:

a Drawn from comparison between SHFS and NT-proBNP values

b drawn from comparison between SHFS + NT-proBNP values and the SHFS

c drawn from comparison of the model based on NT-proBNP values consisting of all selected predictors in the current analysis including age, New York Heart Association class IV chronic heart failure, plasma albumin, neutrophils/lymphocytes, and NT-proBNP values with the SHFS.

Abbreviations: NT-proBNP, N-terminal pro-B-type natriuretic peptide; SHFS, Seattle Heart Failure Score; CI, confidence interval.

Figure 2 Comparison of c-statistic between NT-proBNP values, SHFS, and our model based on NT-proBNP values.

Abbreviations: NT-proBNP, N-terminal pro-B-type natriuretic peptide; SHFS, Seattle Heart Failure Score.

Table 4 Independent determinants of NT-proBNP values

Variablesa	β	95% CI	P
AMI	0.665	0.199–1.131	0.005
NYHA class IV CHF	0.497	0.180–0.815	0.002
Atrial fibrillation	0.807	0.513–1.101	<0.001
BMI (kg/m^2)	−0.048	−0.083 to −0.012	0.009
MDRD-eGFR (mL/min/1.73 m^2)	−0.022	−0.028 to −0.017	<0.001
Plasma albumin (g/L)	−0.076	−0.107 to −0.045	<0.001
CRP (mg/dL)	0.053	0.022–0.085	0.001
Ejection fraction (%)	−0.024	−0.039 to −0.010	0.001
LVMI (g/m)	0.011	0.007–0.016	<0.001
RAD (mm)	0.026	0.002–0.049	0.030

Notes:

a Multiple linear regression model with adjustment of all the factors.

Abbreviations: NT-proBNP, N-terminal pro B-type natriuretic peptide; CI, confidence interval; AMI, acute myocardial infarction; NYHA, New York Heart Association; CHF, chronic heart failure; BMI, body mass index; MDRD-eGFR, estimated glomerular filtration rate calculated by modified Modification of Diet in Renal Disease equation; CRP, C-reactive protein; LVMI, left ventricular mass index; RAD, right atrial diameter.