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首页> 外文期刊>Pulmonary Circulation >Log-Transformation Improves the Prognostic Value of Serial NT-proBNP Levels in Apparently Stable Pulmonary Arterial Hypertension:
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Log-Transformation Improves the Prognostic Value of Serial NT-proBNP Levels in Apparently Stable Pulmonary Arterial Hypertension:

机译：对数转换可改善串行NT-proBNP水平在明显稳定的肺动脉高压中的预后价值：

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N-terminal pro B-type natriuretic peptide (NT-proBNP) is a product of cleavage of the cardiac prohormone pro B-type natriuretic peptide into its active form. It has proven to be a useful biomarker in left heart failure. However, studies examining the utility of serial measurements of NT-proBNP in pulmonary arterial hypertension (PAH) patients have shown mixed results. We compared three methods of predicting adverse clinical outcomes in PAH patients: the change in 6 minute walk distance (6MWD), the change in absolute levels of NT-proBNP and the change in log-transformed levels of NT-proBNP. All PAH patients presenting from March–June 2007 were screened. Patients who were clinically unstable, had abnormal renal function or hemoglobin levels or lacked a prior NT-proBNP were excluded. 63 patients were followed up for adverse clinical outcomes (defined as death, transplantation, hospitalisation for right heart failure, or need for increased therapy). Three methods were used to predict adverse events, i.e.: (a) comparing a 6MWD performed in March–June 2007 and a previous 6MWD. A decrease in 6MWD of ≥30m was used to predict clinical deterioration; (b) comparing a NT-proBNP value measured in March–June 2007 and a previous NT-proBNP. An increase in NT-proBNP of ≥250pg/ml was used to predict clinical deterioration (250pg/ml represented approximately 30% change from the baseline median value of NT-proBNP for this cohort); and (c) comparing the loge equivalents of two consecutive NT-proBNP values. We used the formula: loge(current NT-proBNP) - loge(previous NT-proBNP)=x. A value of x≥+0.26 was used to predict adverse events. This is equivalent to a 30% change from baseline, and hence is comparable to the chosen cut-off for absolute levels of NT-proBNP. A loge difference of ≥+0.26 identifies patients at risk of adverse events with a specificity of 98%, a sensitivity of 60%, a positive predictive value of 89%, and a negative predictive value of 90%. A drop in 6MWD of ≥30m has a specificity of 29%, a sensitivity of 73%, a positive predictive value of 24% and a negative predictive value of 24%. It seems possible to risk-stratify apparently stable PAH patients by following the changes in their serial log-transformed NT-proBNP values. In this small pilot study, this method was better than relying on changes in the actual levels of NT-proBNP or changes in 6MWD. This needs to be validated prospectively in a larger cohort.
机译：N端前B型利尿钠肽（NT-proBNP）是将心脏前激素B型利尿钠肽裂解成活性形式的产物。它已被证明是左心衰竭的有用生物标志物。但是，研究连续测量NT-proBNP在肺动脉高压（PAH）患者中的效用的研究显示出不同的结果。我们比较了三种预测PAH患者不良临床结局的方法：6分钟步行距离（6MWD）的变化，NT-proBNP绝对水平的变化和NT-proBNP对数转化水平的变化。筛选了2007年3月至6月出现的所有PAH患者。临床不稳定，肾功能或血红蛋白水平异常或缺乏先前的NT-proBNP的患者被排除在外。对63名患者进行了不良临床结局随访（定义为死亡，移植，右心衰竭住院或需要增加治疗）。三种方法用于预测不良事件，即：（a）比较2007年3月至6月进行的6MWD与以前的6MWD。 6MWD降低≥30m可用于预测临床恶化; （b）比较2007年3月至6月测得的NT-proBNP值与以前的NT-proBNP。 NT-proBNP≥250pg / ml的增加可用于预测临床恶化（该人群的250pg / ml代表相对于NT-proBNP的基线中值约有30％的变化）; （c）比较两个连续的NT-proBNP值的loge当量。我们使用公式：loge（当前NT-proBNP）-loge（先前NT-proBNP）= x。 x≥+ 0.26的值用于预测不良事件。这等效于相对于基线的30％的变化，因此与NT-proBNP绝对水平的所选临界值相当。 Loge差异≥+ 0.26可以确定具有不良事件风险的患者，特异性为98％，敏感性为60％，阳性预测值为89％，阴性预测值为90％。 ≥30m的6MWD下降具有29％的特异性，73％的灵敏度，24％的正预测值和24％的负预测值。通过追踪他们连续对数转换后的NT-proBNP值的变化，似乎可以对看似稳定的PAH患者进行风险分层。在这项小型先导研究中，此方法优于依赖于NT-proBNP实际水平的变化或6MWD的变化。这需要在更大的队列中进行前瞻性验证。

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