In-hospital percentage BNP reduction is highly predictive for adverse events in patients admitted for acute heart failure: the Italian RED Study.

INTRODUCTION: Our aim was to evaluate the role of B-type natriuretic peptide (BNP) percentage variations at 24 hours and at discharge compared to its value at admission in order to demonstrate its predictive value for outcomes in patients with acute decompensated heart failure (ADHF). METHODS: This was a multicenter Italian (8 centers) observational study (Italian Research Emergency Department: RED). 287 patients with ADHF were studied through physical exams, lab tests, chest X Ray, electrocardiograms (ECGs) and BNP measurements, performed at admission, at 24 hours, and at discharge. Follow up was performed 180 days after hospital discharge. Logistic regression analysis was used to estimate odds ratios (OR) for the various subgroups created. For all comparisons, a P value < 0.05 was considered statistically significant. RESULTS: BNP median (interquartile range (IQR)) value at admission was 822 (412 - 1390) pg\mL; at 24 hours was 593 (270 - 1953) and at discharge was 325 (160 - 725). A BNP reduction of >46% at discharge had an area under curve (AUC) of 0.70 (P < 0.001) for predicting future adverse events. There were 78 events through follow up and in 58 of these patients the BNP level at discharge was >300 pg/mL. A BNP reduction of 25.9% after 24 hours had an AUC at ROC curve of 0.64 for predicting adverse events (P < 0.001). The odds ratio of the patients whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was <46% compared to the group whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was >46% was 4.775 (95% confidence interval (CI) 1.76 - 12.83, P < 0.002). The odds ratio of the patients whose BNP level at discharge was >300 pg/mL and whose percentage decrease at discharge was <46% compared to the group whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was >46% was 9.614 (CI 4.51 - 20.47, P < 0.001). CONCLUSIONS: A reduction of BNP >46% at hospital discharge compared to the admission levels coupled with a BNP absolute value < 300 pg/mL seems to be a very powerful negative prognostic value for future cardiovascular outcomes in patients hospitalized with ADHF.

Effect of Animal ByProducts Fertilization on Durum Wheat in Mediterranean Conditions: Preliminary Results.

This study aims to evaluate the effects of new-BioFertilizing Amendments (BFAs) deriving from fast organic matter decomposition of Animal ByProducts (ABPs) in comparison with ordinary soil organic amendments (compost), mineral N-fertilizers and no fertilization, on durum wheat development and production in a field trial under Mediterranean conditions. Results showed taller plants with heavier spikes and greater vigor in plots fertilized with BFAs when compared to no fertilization and N-fertilization, respectively. Likewise, BFAs fertilization resulted in higher protein content, gluten content, protein yields and higher values of yellow index with respect to no fertilization and N-fertilization. In contrast, lower values for test weight in correspondence of BFAs fertilization as well as no statistically significant differences on grain yield and gluten index were found. These preliminary results suggest that replacing N-fertilization with BFAs can be effective to ensure crop quality and yield stability in Mediterranean conditions.