क्लिनिकल परीक्षण जर्नल
खुला एक्सेस

अमूर्त

Correlates and Short-Term Prognostic Value of Plasma N-Terminal Pro- Brain Natriuretic Peptide Levels among Heart Failure Patients; in a Wake of COVID-19 Pandemic: A Prospective Cohort Study

Mark. P. Mayala*, Khuzeima Khanbhai, Ponsian Peter, Pilly Chillo

Background: Studies conducted in developed countries have found measurements of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) to be important in evaluating Heart Failure (HF) prognosis; however this has not yet been studied in sub-Saharan Africa. The aim of this study was to determine clinical correlates and short-term prognostic value of plasma NT-proBNP levels among HF patients.

Methodology: This was a hospital-based prospective cohort study conducted at Jakaya Kikwete Cardiac Institute, Tanzania from June to December 2020. Patients were consecutively enrolled when they fulfilled the inclusion criteria. Clinical details and NT-proBNP levels were measured at baseline and at 30-day follow-up. Pearson's chi square test was used to associate New York Heart Association (NYHA) functional class and NT-proBNP levels, while Spearman’s correlation coefficient was used to correlate between Left Ventricular Ejection Fraction (LVEF) and NT-proBNP levels. Receiver Operating Characteristic (ROC) curves were drawn to determine the best prognostic cut off points of NT- proBNP levels for the different clinical outcomes. A P-value of <0.05 was considered statically significant.

Results: 155 HF patients were enrolled. Their mean ± SD age was 48 ± 16 years, 52.3% were male and their mean ± SD LVEF was 37.3 ± 10.7%. At baseline, the median (IQR) NT-proBNP levels was 7654 pg/ml (2289, 16000), and the levels dropped to 3383 pg/ml (731, 9785) after 1 month. Baseline plasma levels of NT-proBNP increased as the NYHA functional class worsened, (P=0.018), and with decreasing LVEF (r=-0.65, p<0.05). The ROC curve identified an overall cut-off point for poor prognosis at 18000 pg/ml with 54.4% sensitivity and 93.7% specificity (Area under the Curve (AUC): 0.8). The NT-proBNP cut-off point for mortality was 24500 pg/ml with 100% sensitivity and specificity of 92.54% (AUC: 0.958). The ROC analysis also identified levels of NT-proBNP of ≥ 7899 pg/ml to predict re-hospitalization, with 76% sensitivity and 60% specificity (AUC: 0.68), while levels ≥ 18762.1 pg/ml predicted long hospital stay with a sensitivity of 100% and specificity of 85.62% (AUC: 0.939).

Conclusion: These results demonstrate NT-proBNP is a good measure to predict readmission and mortality of HF patients and can facilitate discussions with patient prognosis and continuity of care. It can differentiate HF patients from COVID-19 patients.