NT-proBNP improves prediction of cardiorenal complications in type 2 diabetes: the Hong Kong Diabetes Biobank

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetologia Pub Date : 2024-11-07 DOI:10.1007/s00125-024-06299-x
Ronald C. W. Ma, Claudia H. T. Tam, Yong Hou, Eric S. H. Lau, Risa Ozaki, Juliana N. M. Lui, Elaine Chow, Alice P. S. Kong, Chuiguo Huang, Alex C. W. Ng, Erik G. Fung, Andrea O. Y. Luk, Wing Yee So, Cadmon K. P. Lim, Juliana C. N. Chan
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Abstract

Aims/hypothesis

N-terminal pro B-type natriuretic peptide (NT-proBNP) is a natriuretic peptide that is strongly associated with congestive heart failure (CHF). The utility of NT-proBNP for prediction of cardiovascular events and renal endpoints, compared with clinical risk factors, has not been evaluated in detail. We hypothesise that NT-proBNP can improve risk stratification and prediction of cardiorenal events in type 2 diabetes, beyond that provided by clinical risk factors.

Methods

NT-proBNP was measured in 1993 samples from the Hong Kong Diabetes Biobank, a multicentre prospective diabetes cohort and biobank. A cut-off of ≥125 pg/ml was used to define elevated NT-proBNP. Associations between elevated NT-proBNP and incident cardiovascular and renal endpoints were examined using Cox regression, adjusted for sex, age and duration of diabetes, as well as other covariates. Prognostic and incremental predictive values of NT-proBNP in diabetes cardiorenal complications, compared with those of the Joint Asia Diabetes Evaluation risk equations for CHD, CHF and kidney failure, were evaluated using the concordance index (C index), net reclassification improvement index, integrated discrimination improvement index and relative integrated discrimination improvement index.

Results

A total of 24.7% of participants had elevated NT-proBNP. Participants with elevated NT-proBNP at baseline had a more adverse cardiometabolic profile, with 2–4-fold higher frequency of complications at baseline. Adjusting for age at baseline, sex and duration of diabetes, elevated NT-proBNP was associated with incident atrial fibrillation (HR 4.64 [95% CI 2.44, 8.85]), CHD (HR 4.21 [2.46, 7.21]), CVD (HR 3.32 [2.20, 5.01]) and CHF (HR 4.18 [2.18, 8.03]; all p<0.001). All these associations remained significant after further adjustment for additional covariates. Elevated NT-proBNP had good discriminative ability for various cardiorenal endpoints, with C index of 0.83 (95% CI 0.76, 0.90) for CHD, 0.88 (0.81, 0.94) for atrial fibrillation, 0.89 (0.83, 0.95) for CHF, 0.81 (0.77, 0.84) for 40% drop in eGFR and 0.88 (0.84, 0.92) for kidney failure. Models incorporating NT-proBNP had improved prediction compared with established clinical risk models. Sensitivity analyses including alternative cut-off of NT-proBNP, as well as use of other risk engines of CHD, yielded similar results.

Conclusions/interpretation

NT-proBNP demonstrated a promising ability to serve as a prognostic marker for a variety of cardiorenal complications in type 2 diabetes. Considering NT-proBNP in clinical assessments could potentially help identify high-risk individuals who may benefit from more intensive therapies.

Graphical Abstract

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NT-proBNP可提高对2型糖尿病心肾并发症的预测能力:香港糖尿病生物数据库
目的/假设N-末端前 B 型利钠肽 (NT-proBNP) 是一种与充血性心力衰竭 (CHF) 密切相关的利钠肽。与临床风险因素相比,NT-proBNP 在预测心血管事件和肾脏终点方面的作用尚未得到详细评估。我们假设,NT-proBNP 可改善 2 型糖尿病患者的风险分层和心肾事件预测,而临床风险因素则无法提供这样的预测结果。方法NT-proBNP 是在香港糖尿病生物库(一个多中心前瞻性糖尿病队列和生物库)1993 年的样本中测定的。NT-proBNP≥125 pg/ml是NT-proBNP升高的界值。在对性别、年龄和糖尿病持续时间以及其他协变量进行调整后,采用 Cox 回归法检测了 NT-proBNP 升高与心血管和肾脏终点事件之间的关系。使用一致性指数(C 指数)、净再分类改进指数、综合鉴别改进指数和相对综合鉴别改进指数,评估了 NT-proBNP 与亚洲糖尿病联合评估风险方程对糖尿病心肾并发症的预测价值和增量预测价值。基线时NT-proBNP升高的参试者的心脏代谢情况更差,基线时并发症的发生率高出2-4倍。对基线年龄、性别和糖尿病病程进行调整后,NT-proBNP 升高与心房颤动(HR 4.64 [95% CI 2.44, 8.85])、冠心病(HR 4.21 [2.46, 7.21])、心血管疾病(HR 3.32 [2.20, 5.01])和冠心病心房颤动(HR 4.18 [2.18, 8.03];所有 p<0.001)的发生率相关。在对其他协变量进行进一步调整后,所有这些相关性仍然显著。NT-proBNP 升高对各种心肾终点具有良好的鉴别能力,CHD 的 C 指数为 0.83 (95% CI 0.76, 0.90),心房颤动为 0.88 (0.81, 0.94),CHF 为 0.89 (0.83, 0.95),eGFR 下降 40% 为 0.81 (0.77, 0.84),肾衰竭为 0.88 (0.84, 0.92)。与已建立的临床风险模型相比,纳入 NT-proBNP 的模型具有更好的预测效果。结论/解释NT-proBNP显示了作为2型糖尿病患者各种心肾并发症预后标志物的良好能力。在临床评估中考虑NT-proBNP可能有助于识别可能从更多强化治疗中获益的高危人群。
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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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