Inflammatory Markers, Amino-Terminal Pro-Brain Natriuretic Peptide, and Mortality Risk in Dyspneic Patients

Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
American Journal of Clinical Pathology (Impact Factor: 2.51). 08/2008; 130(2):305-11. DOI: 10.1309/L7BP57F7UF7YNYKX
Source: PubMed


Dyspnea is a common emergency department (ED) complaint, and it may be associated with significant mortality risk. We studied 599 dyspneic subjects enrolled in an ED. At 1 year, the role of inflammatory markers (including C-reactive protein [CRP]) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) as independent predictors of mortality was assessed. By 1 year, 91 subjects (15.2%) had died. Among patients who died, the median CRP concentration at admission was significantly higher than in survivors: 47.2 mg/L (449.5 nmol/L; interquartile range [IQR], 10.2-101.9 mg/L [97.1-970.5 nmol/L]) vs 7.25 mg/L (69.5 nmol/L; IQR, 2.2-29.6 mg/L [21.0-281.9 nmol/L]; P < .001). For 1-year mortality, CRP had an area under the receiver operating characteristic curve of 0.76 (95% confidence interval [CI], 0.69-0.80; P < .001). In multivariable analysis, a CRP concentration greater than 14 mg/L was a strong predictor of mortality at 1 year (hazard ratio, 2.47; 95% CI, 1.51-4.02; P < .001). In multivariable models, CRP and NT-proBNP demonstrated independent and additive prognostic value. Among dyspneic patients, CRP levels are significantly associated with mortality at 1 year and show additive value to natriuretic peptide testing for prognosis.

5 Reads
  • Clinical Research in Cardiology Supplements 04/2010; 5:21-26. DOI:10.1007/s11789-010-0008-9
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular disease (CVD) is the single greatest cause of adult mortality in the western world and, consequently, places a massive burden on healthcare services and the economy. Lifestyles, lack of clearly defined risk assessment criteria, consistently high incidences of misdiagnosis and inappropriate referrals, all contribute significantly to this problem. It also correlates directly with inefficient or non-accessible early detection systems. Over the last decade much research has focused on the identification of cardiac biomarkers that can be used for the detection of cardiac distress and that add value to current risk stratification criteria. An exposition of some of the most consistently cited biomarkers is provided and their current status and potential value as early CVD risk predictors, more accurate diagnostic markers of acute myocardial damage and as reliable prognostic indicators, is evaluated. The particular importance of early prediction and the integral role that point-of-care (POC) testing is expected to play in the future of cardiac care is critically discussed.
    Clinical biochemistry 03/2009; 42(7-8):549-61. DOI:10.1016/j.clinbiochem.2009.01.019 · 2.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of natriuretic peptide testing has expanded considerably over the recent years. Thanks to clinical trials that have demonstrated significant benefits associated with testing for B-type natriuretic peptide (BNP) and its amino-terminal pro-peptide (NTproBNP), testing for these peptides is now ubiquitous in modern medicine. This review will focus on the use of NTproBNP in clinical medicine, with a discussion of the biologic significance of NT-proBNP, its proven present uses and potential future applications.
    Drug News & Perspectives 07/2009; 22(5):267-73. DOI:10.1358/dnp.2009.22.5.1378643 · 3.13 Impact Factor
Show more


5 Reads
Available from