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      Cardiac Troponin T and NT-proBNP for Prediction of 30-Day Readmission or Death in Patients with Acute Dyspnea: Data from the Akershus Cardiac Examination 2 Study

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          Abstract

          Introduction

          N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) measurements are recommended in patients with acute dyspnea. We aimed to assess the prognostic merit of cTnT compared to NT-proBNP for 30-day readmission or death in patients hospitalized with acute dyspnea.

          Methods

          We measured cTnT and NT-proBNP within 24 h in 314 patients hospitalized with acute dyspnea and adjudicated the cause of the index admission. Time to first event of readmission or death ≤30 days after hospital discharge was recorded, and cTnT and NT-proBNP measurements were compared head-to-head.

          Results

          Patients who died (12/314) or were readmitted (71/314) within 30 days had higher cTnT concentrations (median: 32.6, Q1–Q3: 18.4–74.2 ng/L vs. median: 19.4, Q1–Q3: 8.4–36.1 ng/L; p for comparison <0.001) and NT-proBNP concentrations (median: 1,753.6, Q1–Q3: 464.2–6,862.0 ng/L vs. median 984, Q1–Q3 201–3,600 ng/L; for comparison p = 0.027) compared to patients who survived and were not readmitted. cTnT concentrations were associated with readmission or death within 30 days after discharge both in the total cohort (adjusted hazard ratio [aHR]: 1.64, 95% confidence interval [CI]: 1.30–2.05) and in patients with heart failure (HF) (aHR: 1.58, 95% CI: 1.14–2.18). In contrast, NT-proBNP concentrations were not associated with short-term events, neither in the total cohort (aHR: 1.10, 95% CI: 0.94–1.30) nor in patients with adjudicated HF (aHR: 1.06, 95% CI: 0.80–1.40).

          Conclusion

          cTnT concentrations are associated with 30-day readmission or death in patients hospitalized with acute dyspnea, as well as in patients adjudicated HF.

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          Most cited references35

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          2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America

          Circulation, 136(6)
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            A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.

            Serum creatinine concentration is widely used as an index of renal function, but this concentration is affected by factors other than glomerular filtration rate (GFR). To develop an equation to predict GFR from serum creatinine concentration and other factors. Cross-sectional study of GFR, creatinine clearance, serum creatinine concentration, and demographic and clinical characteristics in patients with chronic renal disease. 1628 patients enrolled in the baseline period of the Modification of Diet in Renal Disease (MDRD) Study, of whom 1070 were randomly selected as the training sample; the remaining 558 patients constituted the validation sample. The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equations in the validation sample. To simplify prediction of GFR, the equation included only demographic and serum variables. Independent factors associated with a lower GFR included a higher serum creatinine concentration, older age, female sex, nonblack ethnicity, higher serum urea nitrogen levels, and lower serum albumin levels (P < 0.001 for all factors). The multiple regression model explained 90.3% of the variance in the logarithm of GFR in the validation sample. Measured creatinine clearance overestimated GFR by 19%, and creatinine clearance predicted by the Cockcroft-Gault formula overestimated GFR by 16%. After adjustment for this overestimation, the percentage of variance of the logarithm of GFR predicted by measured creatinine clearance or the Cockcroft-Gault formula was 86.6% and 84.2%, respectively. The equation developed from the MDRD Study provided a more accurate estimate of GFR in our study group than measured creatinine clearance or other commonly used equations.
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              ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.

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                Author and article information

                Journal
                Cardiology
                Cardiology
                CRD
                CRD
                Cardiology
                S. Karger AG (Basel, Switzerland )
                0008-6312
                1421-9751
                5 August 2023
                December 2023
                : 148
                : 6
                : 506-516
                Affiliations
                [a ]Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
                [b ]K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
                [c ]Institute of Clinical Medicine, University of Oslo, Oslo, Norway
                [d ]Division for Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
                [e ]Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
                [f ]Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
                Author notes
                Correspondence to: Magnus Nakrem Lyngbakken, magnus.lyngbakken@ 123456medisin.uio.no
                Article
                533266
                10.1159/000533266
                10733942
                37544298
                60c05bab-8fbb-49a2-bc18-65cb8281327e
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) ( http://www.karger.com/Services/OpenAccessLicense). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.

                History
                : 10 February 2023
                : 24 July 2023
                : 2023
                Page count
                Figures: 4, Tables: 2, References: 35, Pages: 11
                Funding
                This work was supported by a research grant from the Norwegian Research Council (197992/B-07029) to T.O. and H.R. and by internal grants from Akershus University Hospital (41810/340104). Roche Diagnostics supported the study by providing reagents at a reduced price to Akershus University Hospital.
                Categories
                Cardiovascular Biomarkers: Research Article

                cardiac troponin t,n-terminal pro-b-type natriuretic peptide,acute dyspnea,readmission,heart failure

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