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Prognostic utility of the N terminal prohormone of brain natriuretic peptide and the modified Model for End Stage Liver Disease in patients with end stage heart failure.

INTRODUCTION    The N terminal prohormone of brain natriuretic peptide (NT proBNP) is secreted by cardiomyocytes in response to increased wall stress resulting from pressure and volume overload. The modified Model for End Stage Liver Disease (modMELD) scale reflects the systemic effect of heart failure (HF), which includes end-organ congestion and subsequent hepatic and renal dysfunction. OBJECTIVES    The aim of this study was to assess the prognostic accuracy of NT proBNP and the modMELD score, as well as to compare their usefulness in the risk stratification of patients with end-stage HF awaiting orthotopic heart transplantation (OHT). PATIENTS AND METHODS    We retrospectively analyzed the data of 641 consecutive adult patients awaiting OHT between 2012 and 2016. Exclusion criteria included "urgent status", OHT, and removal from the waiting list. Clinical and laboratory data were obtained at the time of admission to the waiting list. The primary endpoint was all-cause mortality during a one-year follow up. RESULTS    In the overall population of 370 patients, the median age was 54.0 (46.0-60.0) years, and 87.6% of the patients were male. During the follow-up period, the mortality rate was 27.6%. The areas under the curve (AUCs) were 0.619 (95% CI: 0.557-0.681) for NT proBNP and 0.870 (95% CI: 0.833-0.906) for modMELD. The difference between the AUC for modMELD and NT proBNP was 0.251 (95% CI: 0.179-0.322, P <0.0001). CONCLUSIONS    The usefulness of NT proBNP in evaluating the prognosis of patients with end stage HF awaiting OHT is limited. The modMELD score is a better prognostic marker of waiting list mortality than the NT proBNP serum concentration.

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