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Scholarly Commons > HCA Healthcare Journal > Vol. 2 > Iss. 3 (2021)

 

Keywords

NT-proBNP; BNP; brain natriuretic peptide; peptide fragments; nerve tissue proteins; heart failure; patient readmission; readmission rates; hospital mortality; length of stay

Disciplines

Cardiology | Internal Medicine

Abstract

Introduction

Serum levels of pro-B-type natriuretic peptide (BNP) and N-terminal (NT) proBNP are measured at admission to assess the likelihood of acutely decompensated heart failure (ADHF). Elevated NT-proBNP levels on initial presentation are a reliable marker of ADHF. However, the prognostic significance of NT-proBNP levels measured on admission remains unknown. With a better understanding of how admitting NT-proBNP levels impacts readmission rates, length of stay and mortality, future prospective studies with specific interventions can be developed to reduce all-cause readmissions, shorten length of stay and reduce mortality.

Methods

In this retrospective study, we evaluated heart failure with reduced ejection fraction (HFrEF) admissions from 2017–2018 with a focus on 30-, 60- and 90-day all-cause readmissions, length of stay (LOS) and in-hospital mortality rate that are predicted by NT-proBNP levels measured on admission. Using the HCA Healthcare Enterprise Data Warehouse, adult patients age 18 to 75 were selected using admission ICD-10 codes for HFrEF. Dialysis patients were excluded. Our search of 90 hospitals yielded 21,445 patients who were stratified into quartiles depending on their admission NT-proBNP levels: group 1 (/ml), group 2 (1670–4274 pg/ml), group 3 (4275–10,499 pg/ml) and group 4 (>10,500 pg/ml).

Results

Readmission Rates: The 60-day all-cause readmission was significantly (p = 0.047) higher in group 4 compared to group 1 (adjusted odds ratio (OR) = 1.116, p = 0.013) and group 2 (adjusted OR = 1.111, p = 0.014). The 90-day all cause readmission for group 4 was also significantly higher when compared to group 1 (adjusted OR = 1.105, p = 0.021).

Length of Stay: Elevated NT-proBNP concentrations were associated with a significantly longer LOS (p

Mortality: Higher inpatient mortality rates were associated with elevated NT-proBNP levels. The mortality rate was 0.9% in group 1 compared to a 4.7% mortality rate in group 4. Adjusted OR for mortality increased with increasing levels of NT-proBNP.

Conclusion

Based on the analysis, higher admitting NT-proBNP levels were associated with significantly higher 60-day all-cause readmission, longer LOS and increased mortality. These findings suggest that measuring NT-proBNP levels at admission may provide an indication of patient outcomes. Prospective studies with targeted strategies can be developed to reduce readmissions, shorten LOS and reduce mortality based on admission NT-proBNP levels.

Erratum

This article was corrected on July 15, 2021, to remove MPH as a credential for Dr. Udani.

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