Prognostic value of N-terminal prohormone B-type natriuretic peptide modified by renal function in patients with acute heart failure.

Abstract

It remains unclear whether renal function and follow-up duration impact the prognostic value of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) in patients with heart failure (HF). A nationwide prospective cohort study was conducted in 4907 adults hospitalized for acute HF, of whom 4766 were eligible for analysis. We used Cox regression to estimate the relative risks and Poisson regression to assess the absolute risks of adverse outcomes associated with NT-proBNP levels at admission. Effect modification by renal function was tested in both Cox and Poisson models. Over a median follow-up period of 4.6 years, patients with the middle and highest NT-proBNP tertiles had hazard ratios (HRs) (95 % CI) of 1.41 (1.24-1.59) and 2.15 (1.89-2.44) for all-cause mortality, 1.59 (1.37-1.85) and 2.35 (2.01-2.74) for cardiovascular mortality, respectively, compared to those with the lowest tertile. These associations diminished over time. The associations between NT-proBNP levels and the risks of mortality (P-for-interaction < 0.01) were modified by estimated glomerular filtration rate (eGFR) levels, remaining significant yet weaker in HF patients with eGFR <30 ml/min/1.73m². The incidence rates of mortality at the same NT-proBNP level were higher in HF patients with lower eGFR (P-for-interaction < 0.05). NT-proBNP levels demonstrated graded associations with the risks of adverse outcomes. As eGFR reduced, its excessive relative risks attenuated, while its absolute risks increased. The associations waned over an extended follow-up period. These findings highlight the prognostic significance of NT-proBNP in patients with reduced renal function and the necessity of its dynamic monitoring.