The Added Value of Bioimpedance Analysis to NT-proBNP in Predicting Short-term outcome in Acute Heart Failure Patients

Putri Annisa Kamila, Mohammad Saifur Rohman, Setyasih Anjarwani, Djanggan Sargowo, Anna Fuji Rahimah, Indra Prasetya, Muhammad Rizki Fadlan, Salvatore Di Somma

Abstract


Background: Acute heart failure (AHF) is a significant clinical problem, which has a high prevalence, mortality, and rehospitalization. Congestion is critical in AHF's pathogenesis, which is also a predictor of mortality and rehospitalization in patients with AHF.

 

Aim: Knowing the effect of adding a %Total body water (TBW) test detected by Bioimpedance Analysis to NT-proBNP as a short-term clinical outside predictor of patients with acute heart failure

 

Method: This research is an analytical observational study using prospective cohort methods. The research was conducted at Dr. Saiful Anwar Malang Hospital in January 2018-July 2019, with research subjects taken consecutively against all AHF patients hospitalized at UD dr.UD dr. Saiful Anwar Malang. The data taken in the form of NT-proBNP value during mission and %TBW before the patient leaves the hospital detected with NICaS examination, then the outside seen is mortality rate and rehospitalization due to AHF within 90 days after exiting the hospital.

 

Results:  This study involved 65 subjects who were 61 years old and the majority male. Non-survivor patients had a higher NYHA class, NT-proBNP, and %TBW predischarge than the survivor group. Based on statistical analysis, we found that NT-proBNP is a good predictor of mortality (HI: AUC 0.74; 95%CI 0.59-0.90) and rehospitalization (HI: AUC 0.88; 95%CI 0.78-0.97). Similarly , %TBW pre-discharge shows good predictors of mortality (HI: AUC 0.72, 95%CI 0.56-0.87) and rehospitalization (HI: AUC 0.83, 95%CI 0.73-0.94). The addition of the %TBW predischarge parameter to NT-proBNP results in the best predictor numbers among the three for both mortality (HI: AUC 0.84; 95%CI 0.72-0.96) and rehospitalization (HI: AUC 0.92; 95%CI 0.85-1.00).

 Conclusion: The addition of predischarge %TBW examination detected by bioimpedance analysis tool against NT-proBNP increases the predicted value of short-term clinical outpatient in the form of mortality and rehospitalization of acute heart failure patients.

Keywords: acute heart failure, NT-proBNP, bioimpedance analysis, total body water


Keywords


Acute Heart Failure; NT-proBNP

Full Text:

PDF

References


Ural D, Çavuşoğlu Y, Eren M, Karaüzüm K, Temizhan A, Yılmaz MB, Zoghi M, Ramassubu K, Bozkurt B. Diagnosis and management of acute heart failure. Anatolian journal of cardiology. 2016 Nov;15(11):860.

Debra K. Moser, Susan K. Frazier, Linda Worrall-Carter, et al. Symptom Variabi-lity, Not Severity, Predicts Rehospitalization and Mortality in Patients with Heart Failure. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 10(2):124–129, June 2011

Adams KF Jr, Fonarow GC, Emerman CL, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149: 209–16.

Colombo PC, Doran AC, Onat D, Yuk Wong K, Ahmad M, Sabbah HN, Demmer RT (2015) Venous congestion, endothelial and neurohormonal activation in acute decompensated heart failure: cause or effect? Curr Heart Fail Rep 12(3):215–222

Tubaro M, Vranckx P, Price S, Vrints C, editors. The ESC textbook of intensive and acute cardiovascular care. Esc Textbook of Preventive Car; 2015.

Oremus M, McKelvie R, Don-Wauchope A, Santaguida PL, Ali U, Balion C, Hill S, Booth R, Brown JA, Bustamam A, Sohel N, Raina P (2014) A systematic review of BNP and NT-proBNP in the management of heart failure: overview and methods. Heart Failure Rev 19:413–419

Shakar SF, Lindenfeld J (2014) Treatment approaches to congestion relief in acute decompensated HF: insight after DOSEAHF and CARESS-HF. Curr Treat Options CardiolMed 16:330

Gheorghiade M, Filippatos G, De Luca L, Burnett J (2006) Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med 119(12 Suppl 1):S3–S10

Valle R,AspromonteN,Milani L, PeacockFW,MaiselAM, Santini M, Ronco C (2011) Optimizing fluid management in patients with acute decompensated heart failure (ADHF): the emerging role of combined measurement of body hydration status and brain natriuretic peptide (BNP) levels. Heart Fail Rev 16(6):519–529

Di Somma S,Navarin S, Giordano S, Spadini F, Lippi G, Cervellin G, Dieffenbach BV,Maisel AS (2012) The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure. Clin Chem Lab Med 50(12):2093–2105

Di Somma S, Lukaski HC, Codognotto M, Peacock EF, Fiorini F, Aspromonte N, Ronco C, Santarelli S, Lalle I, Autunno A, Piccoli A (2011) Consensus paper on the use of BIVA (bioelectrical impedance vector analysis) in medicine for the management of body hydration. Emerg Care J

Massari F, Iacoviello M, Scicchitano P, Mastropasqua F, Guida P, Riccioni G, et al. Accuracy of bioimpedance vector analysis and brain natriuretic peptide in detection of peripheral edema in acute and chronic heart failure. Heart Lung 2016;45:319–26

Massari F, Scicchitano P, Iacoviello M, Passantino A, Guida P, Sanasi M, Piscopo A, Romito R, Valle R, Caldarola P, Ciccone MM. Multiparametric approach to congestion for predicting long-term survival in heart failure. Journal of Cardiology. 2020 Jan 1;75(1):47-52.

Di Somma S, Lalle I, Magrini L, Russo V, Navarin S, Castello L, Avanzi GC, Di Stasio E, Maisel A (2014) Additive diagnostic and prognostic value of bioelectrical impedance vector analysis (BIVA) to brain natriuretic peptide ‘grey-zone’ in patients with acute heart failure in the emergency department. Eur Heart J Acute Cardiovasc Care 3(2):167–175

Kociol RD, McNulty SE, Hernandez AF, Lee LK, Redfield MM, Tracy RP, Braunwald EB, O’Connor MC, Felker GM (2013) Markers of decongestion, dyspnea relief and clinical outcomes among patients hospitalized with acute heart failure. Circ Heart Fail 6:240–245

Lucas C, Johnson W, Hamilton MA, Fonarow GC, Woo MA, Flavell CM (2000) Freedom from congestion predicts good survival despite previous class IV symptoms of heart failure. Am Heart J 140(6):840–847

De Berardinis B, Magrini L, Zampini G, Zancla B, Salerno G, Cardelli P, Di Stasio E, Gaggin HK, Belcher A, Parry BA, Nagurney JT, Januzzi JL Jr., Di Somma S (2014) Usefulness of combining Galectin-3 and BIVA assessment in predicting short and long term events in patients admitted for acute heart failure. Biomed Res Int 2014:983098

Santarelli S, Russo V, Lalle I, De Berardinis B, Navarin S, Magrini L, Piccoli A, Codognotto M, Castello LM, Avanzi GC, Villacorta H. Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure. Internal and emergency medicine. 2017 Jun 1;12(4):445-51.

Donner Alves F, Correa Souza G, Badin Aliti G, Rabelo Silva ER, Clausell N, Biolo A (2015) Dynamic changes in bioelectrical impedance vector analysis and phase angle in acute decompensated heart failure. Nutrition 31:84–89




DOI: https://doi.org/10.21776/ub.hsj.2021.002.01.06

Refbacks

  • There are currently no refbacks.


Copyright (c) 2021 Putri Annisa Kamila

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.