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NT-proBNP is a peptide hormone, which the major source is the ventricular myocardium. Many studies have found that NT-proBNP has an important value in the diagnosis and differential diagnosis, prognosis and guide the treatment of heart failure. But most of studies of the prognostic value were completed in general adult population, and it is not clear in very elderly population (age≥80years). This study aims to investigate the prognistic value of NT-proBNP in very elderly patients.
This is a prospective, cohort study. The very elderly patients (age 80years, n=861) who admitted by the Geriatric Wards of the Chinese PLA General Hospital from Nov 2007 to Oct 2010 were eligible for inclusion, 724 completed a follow-up in 2016. At baseline, collected age, gender, medical history and medication, measured height and weight, completed laboratory examination and echocardiography. New onset mortality and MACEs were recorded at the end of follow-up. Associations between NT-proBNP and outcomes were evaluated with Cox proportional hazard models.
Mean age was 86.6±3.0 years (80-100years), mean NT-proBNP concentration was 770.26±817.72pg/mL at baseline. Multivariate linear regression analysis showed that NT-proBNP was positively correlated with age, AF, sCr, BUN, left artial diameter and application of β-blockers, and negatively correlated with eGFR, TG, hemoglobin(Hb), plasma albumin(ALB), LVEF and BMI. During a median 5.3-year follow-up period, there were 353 patients with death and 202 patients with MACEs. After adjusted for age, gender, Hb, ALB and other risk factors. Cox proportional hazard models analysis showed that NT-proBNP was an independent risk factor of death (HR=1.366; 95CI, 1.045-1.784; p=0.022) and MACEs (HR=1.708; 95CI, 1.127-2.590; p=0.012), but further adjusted the echocardiography parameters, NT-proBNP could not independently predict above risks. The ROC analysis indicated that NT-proBNP had reasonable accuracy for the prediction of death and MACEs when it was 405.8pg/mL. The subgroup analysis found that NT-proBNP was an independent predictor of death in patients with CKD (HR=1.85, 95%CI, 1.090-3.141; p =0.023).
NT-proBNP was an independent predictor of death and MACEs in very elderly population, but echocardiography attenuated the predictive value of NT-proBNP. At present study, the best cut-off point was 405.8pg/mL in very elderly population. NT-proBNP is an independent predictor of death in very elderly paients with CKD.