| Objective:To analyze the change of N-terminal pro-brain Natriuretic Peptide(NT-proBNP)and red blood cell distribution width(RDW)among chronic kidney disease(CKD)stage 3-5 non-dialysis patients with acute heart failure.To obtain the cut-off value of NT-proBNP and RDW in diagnosing acute heart failure among CKD stage 3-5 non-dialysis patients.To explore the clinical significance of the combined diagnosis of NT-proBNP and RDW.Methods:1.Data were collected from a total number of 225 cases of patients who were diagnosed CKD stage 3-5 in the Department of Renal Medicine,affiliated Hospital of North Sichuan Medical College from November 1st,2019 to February 28th,2020.They were divided into the renal failure group(n=111)and the renocardiac failure group(n=114)according to whether they were diagnosed with acute heart failure.80 cases of healthy people were selected as the control group in the same period.This study collected general clinical data(age,gender,blood pressure,blood routine examination,biochemical routine examination,etc.).2.The plasma NT-proBNP level of each group was measured by Electro-chemiluminescence immunoassay,and the whole blood RDW level was measured by automatic blood cell analyzer.3.All the data were analyzed by spass21.0 software.The quantitative data of normal distribution were statistically described by(?)±s,the quantitative data of non-normal distribution were statistically described by median(interquartile range,IQR).One-Way ANOVA,t-test,Mann-Whitney,and Chi-square(χ2)test,Spearman rank correlation analysis were used for statistical analysis.Receiver operating characteristic(ROC)curves were plotted for NT-proBNP and RDW.The optimal cut-off value was calculated with the largest Youden index.When combining NT-proBNP and RDW,binary Logistic regression analysis was performed on the two to generate a joint predictor,and then the ROC curves of the three were drawn.The area under the curve(AUC)was used to evaluate the diagnostic value,P<0.05 was considered statistically significant.Results:1.The median level of plasma NT-proBNP was 47.2pg/ml,924.3pg/ml and 11357.5pg/ml respectively in the control group,renal failure group and renocardiac failure group.The median level of whole blood RDW was 12.8%,13.3%,14.2%respectively in the control group,renal failure group and renocardiac failure group(P<0.05 for all).2.The median levels of plasma NT-proBNP in the renal failure group at stage of CKD 3,CKD 4 and CKD 5 were 166.7pg/ml,563.8pg/ml and 2911.Opg/ml respectively,and in the renocardiac failure group were 3536.5pg/ml,8313.0pg/ml and 35000.Opg/ml respectively.Under the same CKD stage,the level of NT-proBNP in the renocardiac failure group was higher than that in the renal failure group,and the difference was statistically significant(P<0.01).The level of NT-proBNP in the renal failure group or the renocardiac failure group was different during different CKD stages,and the differences were statistically significant(P<0.01).Spearman correlation analysis showed that NT-proBNP was negatively correlated with eGFR in the renal failure group(r=-0.719,P<0.01),was positively correlated with CKD stage(r=0.651,P<0.01).3.The median level of whole blood RDW in CKD stage 3,CKD stage 4 and CKD stage 5 was 13.2%,13.0%and 13.8 respectively in the renal failure group,and was 13.9%,14.25%and 14.3%in the renocardiac failure group respectively.Under the same CKD stage,the level RDW in the renocardiac failure group was higher than that in the renal failure group,and the differences were statistically significant(P<0.01 for all).Under different CKD stages,there was no significant difference in RDW between CKD stage 3 and CKD stage 4 in the renal failure group(P>0.05),there was a statistically significant difference between CKD stage 3,CKD stage 4 and CKD stage 5(P<0.05 for all)in the renal failure group.Under different CKD stages,there was no significant difference in RDW level in the renocardiac failure group(P>0.05).4.The AUC of NT-proBNP in CKD stage 3,CKD stage 4,and CKD stage 5 were 0.943(95%CI:0.89-0.996),0.897(95%CI:0.20-0.974),and 0.908(95%CI:0.853-0.962),respectively.When taking 2236.7pg/ml as the optimal cut-off value for NT-proBNP diagnosing of CKD stage 3patients with acute heart failure,the sensitivity and specificity were 93.3%and 92.6%respectively.When taking 2433.0pg/ml as the optimal cut-off value for NT-proBNP diagnosing of CKD stage 4 patients with acute heart failure,the sensitivity and specificity were 90.0%and 82.4%respectively.When taking 14834.5pg/ml as the optimal cut-off value for NT-proBNP diagnosing in CKD stage 5 patients with acute heart failure,the sensitivity and specificity were 83.3%and 84.0%,respectively.5.The AUC of RDW was 0.778(95%CI:0.725-0.832).When taking 13.85%as the optimal cut-off value for RDW diagnosing of CKD stage 3-5 patients with acute heart failure,the sensitivity and specificity were 82.5%and 64.9%,respectively.6.When combined NT-proBNP and RDW,the AUC diagnosing acute heart failure of CKD stage 3,CKD stage 4 and CKD stage 5 was 0.952(95%CI:0.899-1.0),0.898(95%CI:0.825-0.972)and 0.909(95%CI:0.854-0.963)respectively,which was larger than the AUC of NT-proBNP or RDW single diagnosis.Conclusion:1.Whether they suffer acute heart failure or not,CKD 3-5stage patients’ plasma level of NT-proBNP was probably higher than that of normal people’s.2.With the progression of CKD stage,the plasma NT-proBNP level of patients gradually increased,and the plasma NT-proBNP level of patients with heart failure was higher than that in patients without heart failure.3.Plasma NT-proBNP has a good diagnostic value for CKD3-5 stage non-dialysis patients with acute heart failure.The cut-off value is higher than normal renal function,especially in CKD stage 5,the cut-off value is significantly higher than normal renal function.4.Whole blood RDW has a certain value in the diagnosing of heart failure in CKD stage 3-5 patients.5.The diagnostic value of combined detection of plasma NT-proBNP and whole blood RDW is higher than single one. |
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