Combination of Uric Acid and NT-ProBNP: A More Useful Prognostic Marker for Short-Term Clinical Outcomes in Patients with Acute Heart Failure
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Background/Aims: In patients with heart failure (HF), N-terminal prohormone brain natriuretic peptide (NTProBNP) is a standard prognostic indicator. In addition, uric acid (UA) was recently established as a prognostic marker for poor outcome in chronic HF. The aim of this study was to determine the combined role of UA and NTProBNP as prognostic markers for short-term outcomes of acute heart failure (AHF). Methods: The levels of UA and NT-ProBNP were determined in 193 patients (age, 69 ± 13 years; 76 males) admitted with AHF. Patients were followed for 3 months and evaluated for cardiovascular events, defined as cardiac death and/or readmission for HF. Results: Of the 193 patients, 23 (11.9%) died and 20 (10.4%) were readmitted for HF during the 3-month followup period. Based on univariate analysis, possible predictors of short-term cardiovascular events were high levels of UA and NT-ProBNP, low creatinine clearance, no angiotensin converting enzyme inhibitors or angiotensin receptor blockers, and old age. Multivariate Cox hazard analysis showed that UA levels were independently associated with increased incidence of cardiovascular events (hazard ratio, 1.115; 95% confidence interval, 1.006 to 1.235; p = 0.037). Kaplan-Meier survival analysis revealed that patients with UA levels > 8.0 mg/dL and NT-ProBNP levels > 4,210 pg/mL were at highest risk for cardiac events (p = 0.01). Conclusions: The combination of UA and NT-ProBNP levels appears to be more useful than either marker alone as an independent predictor for short-term outcomes in patients with AHF. (Korean J Intern Med 2010;25:253-259)
Abstract
Background/Aims: In patients with heart failure (HF), N-terminal prohormone brain natriuretic peptide (NTProBNP) is a standard prognostic indicator. In addition, uric acid (UA) was recently established as a prognostic marker for poor outcome in chronic HF. The aim of this study was to determine the combined role of UA and NTProBNP as prognostic markers for short-term outcomes of acute heart failure (AHF). Methods: The levels of UA and NT-ProBNP were determined in 193 patients (age, 69 ± 13 years; 76 males) admitted with AHF. Patients were followed for 3 months and evaluated for cardiovascular events, defined as cardiac death and/or readmission for HF. Results: Of the 193 patients, 23 (11.9%) died and 20 (10.4%) were readmitted for HF during the 3-month followup period. Based on univariate analysis, possible predictors of short-term cardiovascular events were high levels of UA and NT-ProBNP, low creatinine clearance, no angiotensin converting enzyme inhibitors or angiotensin receptor blockers, and old age. Multivariate Cox hazard analysis showed that UA levels were independently associated with increased incidence of cardiovascular events (hazard ratio, 1.115; 95% confidence interval, 1.006 to 1.235; p = 0.037). Kaplan-Meier survival analysis revealed that patients with UA levels > 8.0 mg/dL and NT-ProBNP levels > 4,210 pg/mL were at highest risk for cardiac events (p = 0.01). Conclusions: The combination of UA and NT-ProBNP levels appears to be more useful than either marker alone as an independent predictor for short-term outcomes in patients with AHF. (Korean J Intern Med 2010;25:253-259)
참고문헌 (26)
- Lainchbury JG, "Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath", J Am Coll Cardiol, 42, pp.728~735 (2003)
- Bong Geun Song, "Correlation Between Levels of N-terminal Pro-B-Type Natriuretic Peptide and Degrees of Heart Failure", The Korean Journal of Internal Medicine, 20(1), pp.26~32 (2005), 대한내과학회
- Bettencourt P, "N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients", Circulation, 110, pp.2168~2174 (2004)
- Gardner RS, "N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure", Eur Heart J, 24, pp.1735~1743 (2003)
- Freedman DS, "Relation of serum uric acid to mortality and ischemic heart disease: the NHANES I epidemiologic follow-up study", Am J Epidemiol, 141, pp.637~644 (1995)
- Fang J, "Serum uric acid and cardiovascular mortality: the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey", JAMA, 283, pp.2404~2410 (2000)
- Niskanen LK, "Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study", Arch Intern Med, 164, pp.1546~1551 (2004)
- Verdecchia P, "Relation between serum uric acid and risk of cardiovascular disease in essential hypertension: the PIUMA study", Hypertension, 36, pp.1072~1078 (2000)
- Mazza A, "Predictors of stroke mortality in elderly people from the general population: the cardiovascular study in the elderly", Eur J Epidemiol, 17, pp.1097~1104 (2001)
- Weir CJ, "Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke", Stroke, 34, pp.1951~1956 (2003)
- Bos MJ, "Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study", Stroke, 37, pp.1503~1507 (2006)
- Anker SD, "Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging", Circulation, 107, pp.1991~1997 (2003)
- Nieminen MS, "Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology", Eur Heart J, 26, pp.384~416 (2005)
- Cockcroft DW, "Prediction of creatinine clearance from serum creatinine", Nephron, 16, pp.31~41 (1976)
- Leyva F, "Uric acid in chronic heart failure: a measure of the anaerobic threshold", Metabolism, 47, pp.1156~1159 (1998)
- Leyva F, "Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure", Eur Heart J, 18, pp.858~865 (1997)
- Doehner W, "Uric acid as a prognostic marker in acute heart failure: new expectations from an old molecule", Eur J Heart Fail, 9, pp.437~439 (2007)
- Sakai H, "Serum level of uric acid, partly secreted from the failing heart, is a prognostic marker in patients with congestive heart failure", Circ J, 70, pp.1006~1011 (2006)
- Cappola TP, "Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy", Circulation, 104, pp.2407~2411 (2001)
- Cingolani HE, "The effect of xanthine oxidase inhibition upon ejection fraction in heart failure patients: La Plata Study", J Card Fail, 12, pp.491~498 (2006)
- Struthers AD, "Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study", Heart, 87, pp.229~234 (2002)
- Pascual-Figal DA, "Hyperuricaemia and long-term outcome after hospital discharge in acute heart failure patients", Eur J Heart Fail, 9, pp.518~524 (2007)
- Landmesser U, "Vascular oxidative stress and endothelial dysfunction in patients with chronic heart failure: role of xanthine-oxidase and extracellular superoxide dismutase", Circulation, 106, pp.3073~3078 (2002)
- Anand IS, "Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT)", Circulation, 107, pp.1278~1283 (2003)
- Maeda K, "High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure", J Am Coll Cardiol, 36, pp.1587~1593 (2000)
- Anwaruddin S, "Renal function, congestive heart failure, and amino-terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study", J Am Coll Cardiol, 47, pp.91~97 (2006)