• John Kellett.
• Department of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. kellett@iol.ie
• Can J Cardiol. 2004 May 15; 20 (7): 686-90.

BackgroundBrain natriuretic peptide (BNP) measurement can detect and assess heart failure. However, compared with traditional clinical parameters, its value for predicting the in-hospital mortality of patients with suspected heart disease has not been reported.Study DesignExamination of the ability of 11 continuous and 22 categorical variables, including BNP levels measured at the time of admission, was conducted to predict in-hospital mortality.SettingA small, rural Irish hospital.SubjectsSix hundred forty-two consecutive patients with suspected heart disease admitted as acute medical emergencies.ResultsThirty-eight (5.9%) patients died while in hospital. They had significantly higher BNP levels on admission than did patients subsequently discharged alive (763+/-473 pg/mL versus 368+/-412 pg/mL, P<0.0001). Patients who died in hospital were older; had significantly higher white blood cell counts, blood urea, respiratory rates and modified early warning scores; and had significantly lower blood pressure and hemoglobin levels. Five variables were found to be independent predictors of mortality: a systolic blood pressure of 90 mmHg or less; a hemoglobin level of 100 g/L or less; a white blood cell count greater than 13.0 x 10(9)/L being unwell before the current illness; and a BNP level of 700 pg/mL or greater. The presence of three or more of these variables was associated with an in-hospital mortality rate of 39%.ConclusionsFive independent variables (hypotension, anemia, leukocytosis, prior illness and elevated BNP levels) are comparable predictors of in-hospital mortality in patients with suspected heart disease.

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