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Vol. 58. Issue 2.
Pages 97-105 (April - June 2023)
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Vol. 58. Issue 2.
Pages 97-105 (April - June 2023)
Original article
B-type natriuretic peptide as prognostic marker in primary care patients with and without heart failure
Péptido natriurético tipoB como marcador pronóstico en pacientes de atención primaria con y sin insuficiencia cardiaca
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Ana Paula Arriaga Carvalho Sallesa, Humberto Villacortaa, Wolney de Andrade Martinsa, Evandro Tinoco Mesquitaa, Adson Renato Leitea, Dayse Mary da Silva Correab, Maria Luiza Garcia Rosaa, Mário Luiz Ribeiroa, Antonio José Lagoeiro Jorgea,
Corresponding author
antoniolagoeiro@id.uff.br

Corresponding author.
a Department of Postgraduate Course in Cardiovascular Science at Federal Fluminense University (UFF), Niterói, RJ, Brazil
b Department of Nursing and Business Fundamentals, UFF – Aurora de Afonso Costa Nursing School, Niterói, RJ, Brazil
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Tables (4)
Table 1. Demographic features, baseline, clinical data, comorbidities and/or risk factors of selected individuals.
Table 2. Demographic features, baseline, clinical, laboratory data, comorbidities and/or risk factors of selected individuals.
Table 3. Multiple Cox regression analysis applied to composite outcome.
Table 4. Sensitivity, specificity, accuracy, PPV, NPV and positive and negative likelihood ratios recorded for different BNP cut-off points and composite outcome.
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Abstract
Introduction and objectives

Primary care is the gateway of individuals in healthcare systems. Natriuretic peptides measurement is a simple and accessible technique that can be safely used to identify composite outcomes. The main aim of the current study was to assess B-type natriuretic peptides (BNP) performance as prognostic marker in primary care patients with and without heart failure.

Methods

An observational, retrospective study, deriving from the DIGITALIS study, was conducted with 560 individuals ≥ 45 years old (63.4% women), who had completed 5-year follow-up. Patients were assessed to identify cardiovascular risk factors and the incidence or not of heart failure. Laboratory test, electrocardiogram, and tissue Doppler echocardiography were performed.

Results

Composite outcome of-all-cause death or hospitalization due to cardiovascular disease was observed for 11.4% of individuals (53.1% women). After multivariable cox regression analysis to minimize the effects of confounding variables, BNP maintained statistical significance. The area under the ROC curve recorded for BNP to identify composite outcome was 0.75 (95%CI, 0.672–0.817; P<.0001). BNP cut-off value of 25pg/mL was the best correlated with composite outcome (sensitivity: 72%, specificity: 71%, accuracy: 91%, negative predictive value: 95%, positive likelihood ratio: 24%).

Conclusions

The study has shown that BNP is a death predictor in primary care patients with or without heart failure.

Keywords:
B-type natriuretic peptide
Prognosis
Death
Primary care
Heart failure
Resumen
Introducción y objetivos

La atención primaria es la puerta de entrada de los pacientes a los sistemas sanitarios. La medición de péptidos natriuréticos es una técnica sencilla y accesible que se puede utilizar de forma segura para identificar resultados compuestos. El objetivo principal del estudio actual fue evaluar el rendimiento de los péptidos natriuréticos de tipoB (BNP) como marcador pronóstico en pacientes de atención primaria con y sin insuficiencia cardiaca.

Métodos

Estudio observacional, retrospectivo, derivado del estudio DIGITALIS, realizado con 560 individuos (63,4% mujeres), de 45años o más, que habían completado 5años de seguimiento. Se evaluó a los pacientes para identificar factores de riesgo cardiovascular y la incidencia o no de insuficiencia cardiaca. Se llevaron a cabo exámenes de laboratorio, electrocardiograma y ecocardiografía Doppler tisular.

Resultados

El resultado compuesto por muerte por cualquier causa u hospitalización por enfermedad cardiovascular se observó en el 11,4% de los individuos (53,1% mujeres). El BNP mantuvo la significación estadística incluso después de realizar un análisis de regresión de Cox múltiple para minimizar los efectos de las variables de confusión. El área bajo la curva ROC registrada para el BNP para identificar el resultado compuesto fue de 0,75 (IC95%, 0,672-0,817; p<0,0001). El valor de corte de BNP de 25pg/ml fue el resultado compuesto mejor correlacionado (sensibilidad: 72%; especificidad: 71%; precisión: 91%; valor predictivo negativo: 95%; razón de verosimilitud positiva: 24%).

Conclusiones

El estudio ha demostrado que el BNP es un predictor de muerte en pacientes de atención primaria con o sin insuficiencia cardiaca.

Palabras clave:
Péptido natriurético tipo B
Pronóstico
Muerte
Atención primaria
Insuficiencia cardiaca

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