Original Contribution Determination of a predictive cutoff value of NT-proBNP testing for long-term survival in ED patients with acute heart failure ☆ Yalcin Velibey, MD a, ⁎, Yalcin Golcuk, MD b , Burcu Golcuk, MD c , Deniz Oray, MD d , Ozge Duman Atilla, MD e , Ayfer Colak, MD f , Yusuf Kurtulmus, MD f , Ali Rıza Erbay, MD a , Abdurrahman Yilmaz, MD b , Mehmet Eren, MD g a Bitlis State Hospital, Department of Cardiology, Bitlis, Turkey b Celal Bayar University, Faculty of Medicine, Department of Emergency Medicine, Manisa, Turkey c Merkez Efendi State Hospital, Department of Clinical Biochemistry, Manisa, Turkey d Medical Park Hospital, Department of Emergency Medicine, Izmir, Turkey e Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey f Department of Clinical Biochemistry, Tepecik Training and Research Hospital, Izmir, Turkey g Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey abstract article info Article history: Received 7 July 2013 Received in revised form 12 August 2013 Accepted 13 August 2013 Available online xxxx Objective: The main objective of this study was to determine a predictive cutoff value for plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) that could successfully predict the long-term (4-year) survival of patients with acute heart failure (HF) at the time of admission to the emergency department (ED). To our best knowledge, our study is the first research done to identify a predictive cutoff value for admission NT-proBNP to the prescriptive 4-year survival of patients admitted to ED with acute HF diagnosis. Methods: NT-proBNP levels were measured in plasma obtained from 99 patients with dyspnea and left ventricular dysfunction upon admission to the ED. The end point was survival from the time of inclusion through 4 years. Results: The mean age of the patients in this study was 71.1 ± 10.3 years; 50 of these patients were female. During the 4-year follow-up period, 76 patients died; survivors were significantly younger than non-survivors (64.26 ± 11.42 years vs72.83 ± 11.07 years, P = .002). The optimal NT-proBNP cutoff point for predicting 4- year survival at the time of admission was 2300 pg/mL, which had 85.9% sensitivity and 39.1% specificity (95% confidence interval, area under the curve: 0.639, P = .044). Conclusion: Elevated NT-proBNP levels at the time of admission are a strong and independent predictor of all- cause mortality in patients with acute HF 4 years after admission. Furthermore, the optimal cutoff level of NT- proBNP used to predict 4-year survival had high sensitivity. However, especially in the case of long-term survival, additional prospective, large, and multicenter studies are required to confirm our results. © 2013 Elsevier Inc. All rights reserved. 1. Introduction The prevalence and incidence of congestive heart failure (HF) are increasing worldwide. Due to its high mortality, early diagnosis and treatment of HF, as well as the identification of high-risk groups are very important [1,2]. Natriuretic peptides (B-type natriuretic peptide [BNP] and N-terminal pro-BNP [NT-proBNP]) are produced in both ventricles of the heart (predominantly in the left ventricle) and released into the circulation in response to increased cardiac wall stretching, volume overload or pressure overload. They have been shown to be useful in diagnosing and identifying the severity of HF in dyspneic patients upon admission to the emergency department (ED). Therefore, serial evaluations of the natriuretic peptides may be useful in determining the effectiveness of treatment of HF patients [3-15]. The objective of this study was to determine a cutoff value of plasma NT-proBNP that could successfully predict the long-term (4-year) survival of patients with acute HF at the time of admission to the ED. To the best of our knowledge, our work is the first research done to determine a cutoff value for NT-proBNP at time of admission to the ED that can predict 4- year survival of patients admitted to ED with a diagnosis of acute HF. 2. Materials and methods 2.1. Study design and patient selection This prospective, observational, cross-sectional, single-center study was conducted in the academic ED of a tertiary care hospital. American Journal of Emergency Medicine xxx (2013) xxx–xxx ☆ The authors declare that they have no commercial associations or sources of support that might pose a conflict of interest. ⁎ Corresponding author. Bitli State Hospital, Besminare Str. No:165, Bitlis, Turkey. Tel.: +90 4342468520; fax: +90 4342468425. E-mail address: dr_yalchin_dr@yahoo.com.tr (Y. Velibey). 0735-6757/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajem.2013.08.033 Contents lists available at ScienceDirect American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem Please cite this article as: Velibey Y, et al, Determination of a predictive cutoff value of NT-proBNP testing for long-term survival in ED patients with acute heart failure, Am J Emerg Med (2013), http://dx.doi.org/10.1016/j.ajem.2013.08.033