Nt-ProBNP, Anaemia and Renal function are independent predictors of hospitalization in outpatients with pulmonary artery hypertension
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Damas" "autores" => array:2 [ 0 => array:2 [ "Iniciales" => "M." "apellidos" => "van Zeller" ] 1 => array:2 [ "Iniciales" => "C." "apellidos" => "Damas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915856169?idApp=UINPBA00004E" "url" => "/08732159/0000002100000001/v0_201604141151/X0873215915856169/v0_201604141151/en/main.assets" ] "en" => array:9 [ "idiomaDefecto" => true "titulo" => "Nt-ProBNP, Anaemia and Renal function are independent predictors of hospitalization in outpatients with pulmonary artery hypertension" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "47" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Sargento, S. Longo, N. Lousada, R.P. dos Reis" "autores" => array:4 [ 0 => array:4 [ "Iniciales" => "L." "apellidos" => "Sargento" "email" => array:1 [ 0 => "luisjosesargento@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "S." "apellidos" => "Longo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "N." "apellidos" => "Lousada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "R.P." "apellidos" => "dos Reis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. luisjosesargento@gmail.com" ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara">Dear Editor,</p><p class="elsevierStylePara">The clinical course of pulmonary arterial hypertension (PAH) is highly variable; therefore, reliable parameters are needed to characterize the severity of the disease and to detect the disease progression sensitively. In recent years, several parameters have been tested.<a href="#bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Anaemia and renal function are unspecific markers,<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> while Nt-ProBNP has been extensively studied<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">, </span><a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">, </span><a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> and is recommended in current guidelines.<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> However, renal function may interfere with its levels. We sought to evaluate in patients with PAH, already on specific therapy, which would be the best parameter to predict the long-term hospitalization within the routine laboratory workup.</p><p class="elsevierStylePara">Thirty consecutive adult patients (73.3% women) with PAH, age of 63.7 ± 12.6 years, Group I PAH, on specific pulmonary vasodilator target therapy >12 months (sildenafil 83.3%, bosentan 60%; both 43.3%), stable outpatients (last hospitalization and diuretic therapy changes >3 months) were included in this 2-year clinical follow-up. Also, at inclusion sPAP and mPAP should be >35 mmHg and >25 mmHg, respectively. Our Unit routine laboratorial workup includes the determination of the Nt-ProBNP, complete blood count including haemoglobin, haematocrit, erythrocyte count, red cell distribution width, creatinine and estimated glomerular filtration rate (MDRD equation), hepatic enzymes and the ionogram. Outcome: cardiovascular hospitalization.</p><p class="elsevierStylePara">Besides clinical stability, no recent hospitalization and specific therapy >12 months the sPAP (73.9 ± 24.7 mmHg), pulmonary vascular resistance (3.2 ± 1.2 wood) and Nt-ProBNP (1021 ± 1200 pg/ml) were high. The hospitalization and death rate were 46.7 and 16.7%, respectively. The ROC curve for hospitalization was significant for haemoglobin (AUC = 0.75; <span class="elsevierStyleItalic">p</span> = 0.028), Erythrocytes (AUC = 0.76; <span class="elsevierStyleItalic">p</span> = 0.023), Haematocrit (AUC = 0.73; <span class="elsevierStyleItalic">p</span> = 0.043), Creatinine (AUC = 0.74; <span class="elsevierStyleItalic">p</span> = 0.026), GFR (AUC = 0.73; <span class="elsevierStyleItalic">p</span> = 0.034) and Nt-ProBNP (AUC = 0.79; <span class="elsevierStyleItalic">p</span> = 0.007). The significant cut-off points were calculated from the ROC curve. All these parameters were associated to increased risk of hospitalization (<a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>) and with the hospitalization curve. The multivariate Cox regression (“backward stepwise method) model showed that the Haematocrit < 42.4 (HR = 11.1; <span class="elsevierStyleItalic">p</span> = 0.036), Creatinine < 1.16 (HR = 4.93; <span class="elsevierStyleItalic">p</span> = 0.022) and Nt-ProBNP>895 (HR = 14.9; <span class="elsevierStyleItalic">p</span> < 0.001) were the independent predictors of hospitalization. Patients with at least one of these parameters above the cut-off had greater risk of hospitalization (HR = 5.6; 95% CI 0.73–43.0; <span class="elsevierStyleItalic">p</span> = 0.097).</p><p class="elsevierStylePara">Table 1. Risk estimate, hospitalization curve; and the univariate and multivariate predictors of hospitalization by Cox regression.</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td> </td><td colspan="3">Fisher exact test with risk estimate</td><td>Kaplan–Meier</td><td colspan="5">Cox regression</td></tr><tr align="left"><td> </td><td>OR</td><td>95% CI</td><td><span class="elsevierStyleItalic">P</span> value</td><td>Log-Rank</td><td colspan="2">Univariate analysis</td><td colspan="3">Multivariate analysis<span class="elsevierStyleSup">*</span></td></tr><tr align="left"><td> </td><td> </td><td> </td><td> </td><td> </td><td>HR</td><td><span class="elsevierStyleItalic">P</span> value</td><td>HR</td><td>95% CI</td><td><span class="elsevierStyleItalic">P</span> value</td></tr><tr align="left"><td>Hb < 14.5 g/dl</td><td>2.3</td><td>1.3–3.9</td><td>0.003</td><td>0.006</td><td>48.1</td><td>0.128</td><td>–</td><td> </td><td> </td></tr><tr align="left"><td>Eryth < 4,710,000</td><td>2.2</td><td>1.1–4.4</td><td>0.023</td><td>0.036</td><td>4.43</td><td>0.055</td><td> </td><td> </td><td>NS</td></tr><tr align="left"><td>Ht < 42.4%</td><td>2.1</td><td>1.2–3.8</td><td>0.016</td><td>0.021</td><td>7.68</td><td>0.051</td><td>11.1</td><td>1.16–106.2</td><td>0.036</td></tr><tr align="left"><td>Rdw > 13.6</td><td>1.6</td><td>1.1–2.3</td><td>0.054</td><td>0.047</td><td>32.7</td><td>0.23</td><td>–</td><td> </td><td> </td></tr><tr align="left"><td>Creat > 1.16 mg/dl</td><td>8.0</td><td>1.1–57.3</td><td>0.012</td><td>0.003</td><td>4.43</td><td>0.006</td><td>4.9</td><td>1.26–19.3</td><td>0.022</td></tr><tr align="left"><td>GFR < 77.2 cc/min/1.73 m<span class="elsevierStyleSup">2</span></td><td>2.1</td><td>1.1–4.2</td><td>0.033</td><td>0.038</td><td>3.59</td><td>0.051</td><td> </td><td> </td><td>NS</td></tr><tr align="left"><td>Nt-ProBNP > 895 pg/mL</td><td>3.43</td><td>1.2–10.2</td><td>0.024</td><td>0.003</td><td>4.54</td><td>0.007</td><td>14.9</td><td>3.33–67.2</td><td><0.001</td></tr></table><p class="elsevierStylePara"><span class="elsevierStyleItalic">Abbreviations</span>: Hb, haemoglobin; Eryth, erythrocyte count; Ht, haematocrit; Rdw, red cell distribution width; Creat, creatinine; GRF, glomerular filtration rate (MDRD method). <span class="elsevierStyleSup">*</span> Multivariate analysis “backward stepwise method”. NS, non-significant; OR, odds ratio; HR, hazard ratio; CI confidence interval.<br></br></p><p class="elsevierStylePara">In conclusion, the present data showed that the haematocrit, creatinine and Nt-ProBNP, which characterize the anaemia degree, renal function and heart dysfunction; and are included in the routine follow-up of our Unit, are independent predictors of the 2 years hospitalization curve. These data confirm and reinforce previous data on these prognostic markers.</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Corresponding author. luisjosesargento@gmail.com</p>" "pdfFichero" => "320v21n01a90385618pdf001.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib7" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "The prognostic impact of follow-up assessments in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. 2012; 9:589-96." "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "The prognostic impact of follow-up assessments in patients with idiopathic pulmonary arterial hypertension." 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| 2019 August | 161 | 15 | 176 |
| 2019 July | 165 | 17 | 182 |
| 2019 June | 172 | 10 | 182 |
| 2019 May | 170 | 12 | 182 |
| 2019 April | 155 | 26 | 181 |
| 2019 March | 170 | 12 | 182 |
| 2019 February | 159 | 9 | 168 |
| 2019 January | 183 | 22 | 205 |
| 2018 December | 110 | 9 | 119 |
| 2018 November | 41 | 2 | 43 |
| 2018 October | 42 | 7 | 49 |
| 2018 September | 33 | 5 | 38 |
| 2018 August | 32 | 22 | 54 |
| 2018 July | 45 | 23 | 68 |
| 2018 June | 40 | 11 | 51 |
| 2018 May | 60 | 20 | 80 |
| 2018 April | 84 | 24 | 108 |
| 2018 March | 84 | 13 | 97 |
| 2018 February | 28 | 14 | 42 |
| 2018 January | 66 | 8 | 74 |
| 2017 December | 51 | 23 | 74 |
| 2017 November | 32 | 11 | 43 |
| 2017 October | 13 | 17 | 30 |
| 2017 September | 23 | 12 | 35 |
| 2017 August | 32 | 13 | 45 |
| 2017 July | 18 | 13 | 31 |
| 2017 June | 29 | 16 | 45 |
| 2017 May | 37 | 12 | 49 |
| 2017 April | 24 | 5 | 29 |
| 2017 March | 28 | 5 | 33 |
| 2017 February | 14 | 7 | 21 |
| 2017 January | 11 | 6 | 17 |
| 2016 December | 8 | 6 | 14 |
| 2016 November | 6 | 2 | 8 |
| 2016 October | 5 | 1 | 6 |
| 2016 September | 5 | 5 | 10 |
| 2016 August | 3 | 4 | 7 |
| 2016 July | 6 | 7 | 13 |
| 2016 June | 12 | 4 | 16 |
| 2016 May | 8 | 5 | 13 |
| 2016 April | 11 | 1 | 12 |
| 2016 March | 31 | 22 | 53 |
| 2016 February | 31 | 18 | 49 |
| 2016 January | 32 | 23 | 55 |
| 2015 December | 43 | 18 | 61 |
| 2015 November | 18 | 10 | 28 |
| 2015 October | 15 | 16 | 31 |
| 2015 September | 29 | 14 | 43 |
| 2015 August | 16 | 11 | 27 |
| 2015 July | 6 | 3 | 9 |
| 2015 June | 18 | 6 | 24 |
| 2015 May | 32 | 13 | 45 |
| 2015 April | 40 | 31 | 71 |
| 2015 March | 56 | 40 | 96 |
| 2015 February | 51 | 40 | 91 |
Show all
