{"title":"NT-proBNP预测急性A型主动脉夹层死亡率的临床意义：一项回顾性队列研究","authors":"Shuai Liu, Xiaohui Bian, Qianqian Liu, Rui Zhang, Chenxi Song, Sheng Yuan, Hao Wang, Weida Liu, Jingjing Gao, Xinming Cui, Sijia Qin, Yumeng Li, Chengang Zhu, Rui Fu, Kefei Dou","doi":"10.1136/bmjopen-2024-093757","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Acute type A aortic dissection is a life-threatening cardiovascular disease commonly seen in emergency department, resulting in substantial mortality and morbidity. We aimed to investigate the prognostic value of N-terminal pro-B type natriuretic peptide (NT-proBNP) among this critically ill population.</p><p><strong>Design: </strong>The design of this study was a retrospective cohort study.</p><p><strong>Setting: </strong>The study population was recruited in the Emergency Department of Fuwai hospital in China from 2018 to 2020.</p><p><strong>Participants: </strong>We consecutively enrolled 829 patients with acute type A aortic dissection and measurable baseline NT-proBNP.</p><p><strong>Primary outcome: </strong>The primary endpoint was 1-year all-cause death.</p><p><strong>Results: </strong>Based on tertiles of NT-proBNP (pg/mL), patients were stratified into low (≤150.3, n=276), intermediate (150.3-667.6, n=277) and high (>667.6, n=276) NT-proBNP groups. Compared with patients with low NT-proBNP, the Kaplan-Meier estimates for primary 1-year mortality were higher in intermediate (32.5% vs 18.1%; HR 1.91, 95% CI 1.35 to 2.69) and high (42.0% vs 18.1%; HR 2.56, 95% CI 1.84 to 3.57) NT-proBNP groups, respectively. After multivariable regression adjusted for confounders, NT-proBNP tertiles were independent predictors for 1-year mortality (adjusted HR for intermediate group 1.52, 95% CI 1.02 to 2.27; adjusted HR for high group 2.17, 95% CI 1.41 to 3.32). Notably, the predictive performance of NT-proBNP for 1-year mortality was greater in patients receiving surgery than conservative treatment (between-cohorts difference in area under the curve 0.13, Delong's test p=0.04).</p><p><strong>Conclusion: </strong>NT-proBNP provides incremental prognostic information for mortality in patients with acute type A aortic dissection who underwent surgical repairment, which could aid in risk stratification as a pragmatic and versatile biomarker in this critically ill population while having limited prognostic value for those receiving conservative treatment.</p>","PeriodicalId":9158,"journal":{"name":"BMJ Open","volume":"15 1","pages":"e093757"},"PeriodicalIF":2.3000,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781122/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinical implication of NT-proBNP to predict mortality in patients with acute type A aortic dissection: a retrospective cohort study.\",\"authors\":\"Shuai Liu, Xiaohui Bian, Qianqian Liu, Rui Zhang, Chenxi Song, Sheng Yuan, Hao Wang, Weida Liu, Jingjing Gao, Xinming Cui, Sijia Qin, Yumeng Li, Chengang Zhu, Rui Fu, Kefei Dou\",\"doi\":\"10.1136/bmjopen-2024-093757\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Acute type A aortic dissection is a life-threatening cardiovascular disease commonly seen in emergency department, resulting in substantial mortality and morbidity. We aimed to investigate the prognostic value of N-terminal pro-B type natriuretic peptide (NT-proBNP) among this critically ill population.</p><p><strong>Design: </strong>The design of this study was a retrospective cohort study.</p><p><strong>Setting: </strong>The study population was recruited in the Emergency Department of Fuwai hospital in China from 2018 to 2020.</p><p><strong>Participants: </strong>We consecutively enrolled 829 patients with acute type A aortic dissection and measurable baseline NT-proBNP.</p><p><strong>Primary outcome: </strong>The primary endpoint was 1-year all-cause death.</p><p><strong>Results: </strong>Based on tertiles of NT-proBNP (pg/mL), patients were stratified into low (≤150.3, n=276), intermediate (150.3-667.6, n=277) and high (>667.6, n=276) NT-proBNP groups. Compared with patients with low NT-proBNP, the Kaplan-Meier estimates for primary 1-year mortality were higher in intermediate (32.5% vs 18.1%; HR 1.91, 95% CI 1.35 to 2.69) and high (42.0% vs 18.1%; HR 2.56, 95% CI 1.84 to 3.57) NT-proBNP groups, respectively. After multivariable regression adjusted for confounders, NT-proBNP tertiles were independent predictors for 1-year mortality (adjusted HR for intermediate group 1.52, 95% CI 1.02 to 2.27; adjusted HR for high group 2.17, 95% CI 1.41 to 3.32). Notably, the predictive performance of NT-proBNP for 1-year mortality was greater in patients receiving surgery than conservative treatment (between-cohorts difference in area under the curve 0.13, Delong's test p=0.04).</p><p><strong>Conclusion: </strong>NT-proBNP provides incremental prognostic information for mortality in patients with acute type A aortic dissection who underwent surgical repairment, which could aid in risk stratification as a pragmatic and versatile biomarker in this critically ill population while having limited prognostic value for those receiving conservative treatment.</p>\",\"PeriodicalId\":9158,\"journal\":{\"name\":\"BMJ Open\",\"volume\":\"15 1\",\"pages\":\"e093757\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-01-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781122/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjopen-2024-093757\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjopen-2024-093757","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
目的：急性A型主动脉夹层是急诊科常见的危及生命的心血管疾病，死亡率和发病率高。我们的目的是研究n端前b型利钠肽（NT-proBNP）在危重患者中的预后价值。设计：本研究设计为回顾性队列研究。研究人群于2018 - 2020年在中国阜外医院急诊科招募。参与者：我们连续入组了829例急性A型主动脉夹层和可测量基线NT-proBNP的患者。主要结局：主要终点为1年全因死亡。结果：根据NT-proBNP的分位数（pg/mL）将患者分为NT-proBNP低（≤150.3,n=276）、中（150.3 ~ 667.6,n=277）和高（bb0 667.6, n=276）组。与NT-proBNP较低的患者相比，Kaplan-Meier估计的中级患者1年死亡率更高(32.5% vs 18.1%；HR 1.91, 95% CI 1.35 - 2.69)和高(42.0% vs 18.1%；NT-proBNP组的HR为2.56,95% CI为1.84 ~ 3.57。多变量回归校正混杂因素后，NT-proBNP分位数是1年死亡率的独立预测因子(中间组校正HR为1.52,95% CI为1.02 ~ 2.27；高组调整后的HR为2.17,95% CI为1.41至3.32)。值得注意的是，NT-proBNP对接受手术的患者的1年死亡率的预测性能高于保守治疗（曲线下面积的队列间差异为0.13，Delong检验p=0.04）。结论：NT-proBNP为接受手术修复的急性A型主动脉夹层患者的死亡率提供了渐进式的预后信息，作为一种实用和通用的生物标志物，它有助于危重患者的风险分层，而对接受保守治疗的患者的预后价值有限。
Clinical implication of NT-proBNP to predict mortality in patients with acute type A aortic dissection: a retrospective cohort study.
Objectives: Acute type A aortic dissection is a life-threatening cardiovascular disease commonly seen in emergency department, resulting in substantial mortality and morbidity. We aimed to investigate the prognostic value of N-terminal pro-B type natriuretic peptide (NT-proBNP) among this critically ill population.
Design: The design of this study was a retrospective cohort study.
Setting: The study population was recruited in the Emergency Department of Fuwai hospital in China from 2018 to 2020.
Participants: We consecutively enrolled 829 patients with acute type A aortic dissection and measurable baseline NT-proBNP.
Primary outcome: The primary endpoint was 1-year all-cause death.
Results: Based on tertiles of NT-proBNP (pg/mL), patients were stratified into low (≤150.3, n=276), intermediate (150.3-667.6, n=277) and high (>667.6, n=276) NT-proBNP groups. Compared with patients with low NT-proBNP, the Kaplan-Meier estimates for primary 1-year mortality were higher in intermediate (32.5% vs 18.1%; HR 1.91, 95% CI 1.35 to 2.69) and high (42.0% vs 18.1%; HR 2.56, 95% CI 1.84 to 3.57) NT-proBNP groups, respectively. After multivariable regression adjusted for confounders, NT-proBNP tertiles were independent predictors for 1-year mortality (adjusted HR for intermediate group 1.52, 95% CI 1.02 to 2.27; adjusted HR for high group 2.17, 95% CI 1.41 to 3.32). Notably, the predictive performance of NT-proBNP for 1-year mortality was greater in patients receiving surgery than conservative treatment (between-cohorts difference in area under the curve 0.13, Delong's test p=0.04).
Conclusion: NT-proBNP provides incremental prognostic information for mortality in patients with acute type A aortic dissection who underwent surgical repairment, which could aid in risk stratification as a pragmatic and versatile biomarker in this critically ill population while having limited prognostic value for those receiving conservative treatment.
期刊介绍：
BMJ Open is an online, open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.
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