Prognostic Value and Clinical Utility of NT-proBNP in Acute Emergency Medical Admissions

Overview

Journal Ir J Med Sci

Specialty General Medicine

Date 2022 Oct 24

PMID 36279040

Authors

Richard Conway

Declan Byrne

Deirdre ORiordan

Bernard Silke

Affiliations

Soon will be listed here.

Abstract

Background: NT-proB-type natriuretic peptide (NT-proBNP) is a frequently utilized test in congestive cardiac failure. There is little data on its utility in unselected emergency medical admissions.

Aim: This study aims to investigate the clinical utility and prognostic value of NT-proBNP in emergency medical admissions and to determine whether such testing influenced downstream investigations and length of stay (LOS).

Methods: We report on NT-proBNP tests performed in emergency medical admissions in a 2005/2006 and subsequent 7-year (2014-2020) retrospective cohort. We assessed 30-day in-hospital mortality with a multivariable logistic regression model. The utilization of procedures/services was related to LOS with zero-truncated Poisson regression.

Results: There were 64,212 admissions in 36,252 patients. Patients with a NT-proBNP test were significantly older at 75.3 years vs. 63.0 years and had longer LOS -9.4 days vs. 4.9 days. They had higher acute illness severity and comorbidity scores. Thirty-day in-hospital mortality was higher in those with a NT-proBNP test (8.8%) vs. no request (3.2%). NT-proBNP test level was prognostic in univariate - OR 2.87 (2.61, 3.15), and multivariate analyses - OR 1.40 (1.26, 1.56). Higher NT-proBNP levels predicted higher 30-day in-hospital mortality. Multivariable thirty-day in-hospital mortality was 3.8% (3.6%, 3.9%) for those without a test, increasing to 4.9% (4.7%, 5.2%) for ≥ 250 ng/L and 5.8% (5.8%, 6.3%) for ≥ 3000 ng/L. LOS was linearly related to the total number of procedures/services performed.

Conclusion: NT-proBNP is prognostic in emergency medical admissions. Downstream resource utilization differed following an NT-proBNP test; this may reflect different case complexity or the 'uncertainty' surrounding such admissions.

Citing Articles

Red Cell Distribution Width as a Prognostic Indicator in Acute Medical Admissions.

Conway R, Byrne D, ORiordan D, Silke B J Clin Med. 2023; 12(16).

PMID: 37629466 PMC: 10455471. DOI: 10.3390/jcm12165424.

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