Value of NT-proBNP level in predicting prognosis of hospitalized elderly pneumonia patients without heart failure history

doi:10.16150/j.1671-2870.2019.03.014

Abstract

Abstract:

Objective: To analyze the value of NT-proBNP level in predicting prognosis of elderly pneumonia patients without heart failure history. Methods: A total of 503 hospitalized elderly pneumonia patients without heart failure history admitted from June 2015 to December 2018 and had NT-proBNP level detected at emergency room were enrolled. According to the interquartile range of serum NT-proBNP, patients were divided into low level group, lower level group, higher level group, and high level group. And according to the occurrence of death in hospital, patients were divided into death group (n=125) and survival group (n=378). The receiver operating characteristic curve (ROC) was used to analyze the predictive value of NT-proBNP on prognosis of elderly pneumonia patients without heart failure history and the optimal cutoff value.And multi-factor Cox regression analysis was used to analyze the influence of NT-proBNP level on prognosis of elderly pneumonia patients without heart failure history. Results: There was a difference in mortality between different groups of NT-proBNP level, and it was the highest in high level group (49.2%) (P<0.05). Compared with survival group, the NT-proBNP, serum creatinine, C reactive protein level were significantly higher and hemoglobin, serum albumin, estimated glomerular filtration rate were significantly lower（P<0.05）in death group; the occurrence of atrial fibrillation was higher and use of RAS blockers before admission was lower (P<0.05). Area under ROC (AUC) of NT-proBNP to predict in-hospital death was 0.714(95%CI: 0.504-0.925, P<0.01). The optimal cut-off value was 1 377.8 pg/mL, with a sensitivity of 75.8% and a specificity of 76.4%. Cox regression analysis indicated that NT-proBNP level（≥1 377.8 pg/mL）, hemoglobin (<131 g/L) and serum albumin(<35 g/L) were independent risk factors for the hospitalized elderly pneumoniapatients without heart failure (P<0.05). Conclusions: Serum NT-proBNP level has a substantial value for predicting the prognosis in elderly pneumonia patients without heart failurehistory.

Key words: NT-proBNP, Elderly patient, Pneumonia, Without heart failure history, Prognosis

CLC Number:

R563.1

LUO Xiaoying, ZHU Xuemei, XU Yan, ZHANG Fengru, WU Liqun, QI Wenhang. Value of NT-proBNP level in predicting prognosis of hospitalized elderly pneumonia patients without heart failure history[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 319-322.

Figures/Tables 4

References 12

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组别	死亡例数（n）	死亡率（%）
低水平组（n=125）	9	7.2
较低水平组（n=125）	20	16.0
较高水平组（n=125）	33	26.4
高水平组（n=128）	63	49.2^a)

项目	死亡组（n=125）	生存组（n=378）
年龄（岁）	88.4±3.7	85.9±4.8
男性（%）	31.8	36.4
收缩压 (mmHg)	121.2±34.9	129.1±22.7
心率（次/分）	77.6±19.5	82.6±22.4
合并疾病 (%)
高血压	24.1	32.1
慢性阻塞性肺疾病	31.7	39.0
冠心病	22.3	18.4
慢性肾病	20.0	24.9
糖尿病	15.0	17.2
房颤	35.8^a)	16.1
NT-proBNP（ng/mL）（急诊）	2091.7±723.3^a)	826.2±572.3
血红蛋白(g/L)	108.7±16.3^a)	138.7±14.6
血白细胞总数(×10⁹/L)	8.3±4.7	9.2±5.8
中性粒细胞（%）	66.2±18.1	62.4±15.7
丙氨酸氨基转移酶（IU/L）	56.3±10.4	54.6±11.7
天冬氨酸氨基转移酶（IU/L）	22.3±15.4	26.7±11.4
白蛋白（g/dL）	27.3±5.6^a)	45.0±8.8
总胆红素(μmol/L)	26.7±8.6	25.9±8.0
血肌酐(μmol/L)	159.8±19.2^a)	123.2±17.4
肾小球滤过率[mL/（min·1.73 m²）]	47.7±11.5^a)	63.3±12.6
空腹血糖(mmol/L)	7.2±4.9	6.0±1.9
餐后2 h血糖(mmol/L)	10.5±6.2	11.8±4.3
糖化血红蛋白(%)	9.4±3.7	8.9±2.1
高敏肌钙蛋白I(ng/mL)	0.2±0.1	0.3±0.1
C反应蛋白(mg/dl)	10.2±3.6^a)	6.8±2.2
低密度脂蛋白(mmol/L)	3.3±1.1	2.9±1.5
血钠 (mmol/L)	137.6±7.3	136.6±6.7
血钾（mmol/L）	4.1±0.8	4.2±0.7
心动超声图指标
左心房(mm)	43.3±7.6	42.8±4.1
左心室舒张末期内径（mm）	52.4±7.7	50.0±5.8
左心室收缩末期内径（mm）	34.9±7.2	35.6±6.8
左心室射血分数（%）	53.3±3.1	56.4±4.7
E/E'	10.6±4.5	9.8±5.3
心动超声图像清晰率（%）	68.8	72.4
合并用药（%）
RAS抑制剂	19.2^a)	37.4
β受体阻滞剂	18.3	19.2
钙拮抗剂	14.4	15.6
利尿剂	10.8	12.9
抗血小板药物	26.7	28.3
他汀	19.2	22.6

日期	死亡组(n=125)	生存组(n=378)
入院前（急诊）	2091.7±723.3^a)	826.2±572.3
入院后第1天	2010.3±705.6^a)	801.6±512.9
入院后第3天	1882.3±697.2^a)	600.3±389.7
入院后第7天	1664.5±699.4^a)	401.7±153.4^b)

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