Gesundheitswesen 2017; 79(08/09): 656-804
DOI: 10.1055/s-0037-1605816
Vorträge
Georg Thieme Verlag KG Stuttgart · New York

Association of established N-Terminal pro-Brain Natriuretic Peptide predictors varies across quantiles in older people: The ActiFE Study

U Braisch
1   Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
2   Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
3   Universität Ulm, Inst. für Epidemiologie und Medizinische Biometrie, Ulm
,
D Dallmeier
1   Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
2   Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
,
W Koenig
4   Universität Ulm, Innere Medizin II, Ulm
5   Deutsches Herzzentrum München, München
,
D Rothenbacher
3   Universität Ulm, Inst. für Epidemiologie und Medizinische Biometrie, Ulm
,
MD Denkinger
1   Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
2   Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
01. September 2017 (online)

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    Background:

    N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) is an established marker for myocardial stress. We evaluated the association of established predictors of NT-proBNP across its quantiles in older people.

    Methods:

    NT-proBNP levels were measured in participants at the Activity and Function in the Elderly in Ulm study-ActiFE Ulm. Quantile regression evaluated the association of age, sex, body mass index (BMI), smoking, cystatin C based glomerular filtration rate (GFR), hemoglobin (Hb), testosterone, C-reactive protein (CRP), history of hypertension (HTN), diabetes (DM), myocardial infarction (MI), heart failure (HF), and stroke with baseline NT-proBNP levels at the 0.10, 0.25, 0.50, 0.75 and 0.90 quantiles. Continuous variables were standardized (mean 0, SD 1) to facilitate comparison of estimated ß-coefficients.

    Results:

    In our study sample (n = 1456, mean age 75.5 years, 56.9% male) NT-proBNP was not normally distributed (median 153.0 ng/L [Q1 81.9, Q3 318.0]). Multivariable analysis showed a significant steady increment of ß-estimates across quantiles for age (ß 14.5, 22.6, 37.2, 77.3, 117.4), CRP (ß 10.1, 25.7, 52.0, 61.5, 106.8), HTN (ß 3.0, 18.7, 34.7, 63.7, 80.7), MI (ß 49.2, 96.4, 213.5, 290.7, 684.8), and HF (ß 32.8, 49.7, 106.9, 418.5, 704.7). Nevertheless, increments of BMI (ß -5.3, -12.2, -21.0, -23.8, -53.6), GFR (ß -10.5, -19.5, -36.7, -78.5, -196.9) and Hb (ß -9.5, -11.0, -24.1, -40.1, -37.2) were significantly associated with lower NT-proBNP levels across the quantiles.

    Conclusion:

    Age, BMI, GFR, Hb, CRP, HTN, MI, and HF are significantly associated with baseline NT-proBNP levels after adjustment for sex, smoking, testosterone, stroke and DM. However, their level of contribution varies considerably for each variable across the quantiles. Quantile regression provides a better description of the relationship between NT-proBNP levels and its predictors, allowing a better understanding of the possible underlying pathophysiological mechanisms.


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