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Prognostic value of emergency department testing for N-terminal fragment of brain natriuretic peptide in patients with acute heart failure: the PICASU-1 study

Jacob J, Llorens Soriano P, Martín-Sánchez FJ, Herrero Puente P, Álvarez Argüelles A, Pérez-Durá MJ, Noval De La Torre A, Segura F, Richard Espiga F, Giménez Valverde A, Miró O

Servicio de Urgencias. Hospital Universitari de Bellvitge. L’Hospitalet de Llobregat. Barcelona, Spain. Servicio de Urgencias-UCE y UHD. Hospital General Universitario de Alicante. Alicante, Spain. Servicio de Urgencias-UCE. Hospital Clínico San Carlos de

Objective: To determine the usefulness of hospital emergency department testing for
the N-terminal fragment of brain natriuretic peptide (NT-proBNP) as a predictor of
mortality and revisits in patients with acute heart failure (AHF).
Methods: The PICASU-1 study (NT-proBNP in AHF in the Emergency Department) was an
analytical multicenter cohort study that included 641 patients with AHF attended at 9
emergency departments that were able to perform emergency NT-proBNP tests. Data
collected included 18 variables related to the patient’s baseline situation and 21 variables
related to the episode of AHF. The area under the receiver operating characteristic curves
(AUC) were calculated to assess the ability of NT-proBNP level to predict in-hospital mortality,
30-day mortality, and revisiting. Ninety-day survival curves were also constructed.
Results: Elevated NT-proBNP concentrations were found in patients who died in hospital
and within 30 days of emergency care (P<.001, both cases). No differences were seen
between patients who revisited within 30 days and those who did not (P=.91). The 90-
day survival curves gave similar results. NT-proBNP concentration had a moderate ability
to predict mortality in-hospital (AUC, 0.75; P<.001) and within 30 days (AUC, 0.71;
P<.001), but no predictive power for revisiting (AUC, 0.50; P=.92). These results were
consistent with those for the 244 patients who were discharged home from the
emergency department (38.3%): the NT-proBNP levels were higher for those who died
within 30 days (P<.01) but similar for revisiting and nonrevisiting patients (P=.50). In
these patients, NT-proBNP level once again had moderate predictive power for 30-day
mortality (AUC, 0.72; P<.01) but no association with revisiting (AUC, 0.47; P=.50).
Conclusion: NT-proBNP testing seems useful for predicting the likelihood of death for a particular
patient with AHF, but it has no ability to predict ED revisiting.

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