© 2005 European Society of Cardiology
Pre-discharge B-type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit
a II Unit of Internal Medicine, Azienda Ospedaliera Universitaria Careggi Florence, Italy
b II Unit of Nuclear Medicine, Azienda Ospedaliera Universitaria Careggi Florence, Italy
c Department of Cardiovascular Medicine, Azienda Ospedaliera Universitaria Careggi Florence, Italy
* Corresponding author. Via A. Faccioli No. 41, 50145 Florence, Italy. Tel.: +39 55 4277411; Fax: +39 55 4277313. E-mail address: valerioverdiani{at}virgilio.it
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Abstract |
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Background: B-type natriuretic peptide (BNP) represents a promising predictor of early (30 days) re-admission in patients with heart failure (HF) admitted to cardiology units. Whether BNP retains its predictive value in unselected patients admitted to general medical wards is unknown.
Methods: We determined BNP levels on admission and pre-discharge in 100 consecutive patients (71 male, mean age 78±10 years) admitted to a general medical unit due to decompensated HF. Follow-up after discharge was 30 days.
Results: Of the 100 patients, 86 had 
1 comorbid conditions. Median BNP was 739 pg/ml on admission (25th–75th percentile 355–1333 pg/ml, respectively), and 414 pg/ml pre-discharge (25th–75th percentile 220–696 pg/ml). Seventeen patients were re-admitted or died within 30 days. Patients with pre-discharge BNP values >75th percentile (696 pg/ml) had greater risk of re-hospitalisation, as compared to values 
696 pg/ml (56% vs. 4%, respectively; p<0.001). Negative predictive value for this cut-off was 96%. BNP values >75th percentile were associated with a 15.0 independent relative hazard (RH) of early re-admission or death (95% CI 4.2–53.8; p<0.0001). The other independent predictor was a NYHA class III at discharge (RH 2.9; 95% CI 1.1–9.3; p<0.05).
Conclusion: In a general medical unit, pre-discharge BNP levels were a strong independent predictor of early re-admission or death due to HF, irrespective of substantial comorbidity and advanced age.
Key Words: Heart failure • Natriuretic peptides • Prognosis • Hospital re-admission
Received July 27, 2004; Revised October 29, 2004; Accepted December 20, 2004
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