| Background:plasma N-terminal pro-B-type natriuretic peptide (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 (HF). But most of studies of the prognostic value were completed in patients with HF, and it is not clear in general population with lower risk of death and major adverse cardiovascular events (MACEs) or very elderly patients (age>80years) with higher risk of death and MACEs. This study aims to investigate the prognostic value of NT-proBNP in general population and very elderly patients.Method:This is a prospective, cohort study. In the first part, the apparent health of residents (age>45years) from two communities in Beijing conducted for a routine health status checkup and 1859 individuals who were eligible for inclusion from Sept 2007 to Jan 2009,1499 completed a follow-up and were assessed for the prognostic value of NT-proBNP in Sept 2013. In the second part, the very elderly patients (age80years, 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 Jan 2016. At baseline, collected age, gender, medical history and medication, measured height and weight, completed laboratory examination, and echocardiography was performed in very elderly patients. 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.Results:In community population, mean NT-proBNP concentration was 41.6pg/mL (IQR,19.8-81.9pg/mL) at baseline. Multivariate linear regression analysis showed that NT-proBNP was positively correlated with age, female and SBP, and negatively correlated with eGFR and DBP. During a median 4.8-year follow-up period, there were 52 participants with death and 154 participants with MACEs. After adjusted for age, gender, eGFR and other risk factors, Cox proportional hazard models analysis showed that elveated levels of NT-proBNP were significantly related to death(HR=3.59,95%CI,1.22-8.81; p＜0.001) and MACEs(HR=3.169,95%CI, 1.64-6.09;p＜0.001). The ROC analysis indicated that NT-proBNP had reasonable accuracy for the prediction of death and MACEs when it was 81.7pg/mL. In the very elderly (≥80years) population, mean age was 86.6±3.0 years (range: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, Urea nitrogen, LAD and application of beta receptor blockers, and negatively correlated with eGFR, TG, hemoglobin, plasma albumin, LVEF and BMI. During a median 5.3-year (IQR2.7-6.6 years) follow-up period, there were 353 patients with death and 202 patients with MACEs. After adjusted for age, gender, hemoglobin, plasma albumin and other risk factors, Cox proportional hazard models analysis showed that NT-proBNP was an independent risk factor of death (HR=1.366; 95%CI,1.045-1.784; p-0.022) and MACEs (HR=1.708; 95%CI,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) and left ventricular hypertrophy (LVH) (HR=1.585,95%CI,0.962-2.612; p=0.041).Conclusion:Many factors influence the plasma concentration of NT-proBNP. NT-proBNP was an independent predictor of death and MACEs in community population and very elderly patients, but echocardiography attenuated the predictive value of NT-proBNP. At present study, the best cut-off point was 81.7pg/mL and 405.8pg/mL in community population and very elderly patients, respectively. NT-proBNP is an independent predictor of death in very elderly patents with CKD and LVH. |
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