Prognostic Value of BNP Reduction During Hospitalization in Patients With Acute Heart Failure.

BACKGROUND: Prognostication of patients discharged after acute heart failure (AHF) hospitalization remains challenging. Body weight (BW) reduction is often used as a surrogate marker of decongestion despite the paucity of evidence. We thought to test the hypothesis that B-type natriuretic peptide (BNP) reduction during hospitalization has independent prognostic value in AHF. METHODS AND RESULTS: We studied the prognostic predictability of percentage BNP reduction achieved during hospitalization in patients from the REALITY-AHF study. Percentage BNP reduction was defined as (BNP on admission - BNP at discharge) / BNP on admission × 100. The primary endpoint was 1-year all-cause death. In 1028 patients (age, 77 ± 13 years; 57% male; left ventricular ejection fraction, 47 ± 16%) with AHF, median BNP level at admission was 747 ng/L (interquartile range, 439-1367 ng/L) and median percentage BNP reduction was 62.5% (interquartile range, 36.5-78.5%). The smallest percentage BNP reduction quartile had more than 2-fold higher risk of all-cause death than the greatest quartile (23.0% vs 9.7%, P< .001). After adjusting for covariates including BNP at discharge, the percentage BNP reduction was significantly associated with all-cause death (hazard ratio 0.96, 95% confidence interval 0.93-0.99, P= .032), whereas percentage BW reduction was not. Percentage BNP reduction was more predictive in patients with heart failure with reduced ejection fraction than in those with preserved ejection fraction. CONCLUSIONS: The prognostic value of percentage BNP reduction during hospitalization was superior to that of percentage BW reduction and was independent of other risk markers, including BNP at discharge.

Social isolation is associated with 90-day rehospitalization due to heart failure.

BACKGROUND: Social isolation has been reported to be associated with decreased quality of life and the onset of organic diseases. The objective of this study was to investigate the prevalence of social isolation in patients with heart failure and whether it is associated with rehospitalization. METHODS AND RESULTS: The study included consecutive patients aged ⩾55 years who were hospitalized due to heart failure. Social isolation was assessed using total scores less than 12 on an abbreviated version of the Lubben Social Network Scale. The endpoint was heart failure rehospitalization within 90 days after discharge. Among 148 patients with heart failure (80±8 years old, 51% male), 73 (49%) were socially isolated. The patients with social isolation had similar comorbidities compared with those without social isolation. Heart failure rehospitalization occurred within 90 days for 25 patients and the heart failure rehospitalization rate was significantly higher in the social isolation group ( p=0.036). LASSO (least absolute shrinkage and selection operator) regression confirmed that social isolation was one of the strongest predictors of heart failure rehospitalization, showing larger effects than living alone, being unemployed, and other established risk factors. CONCLUSION: Half of the patients with heart failure reported social isolation, which had a strong association with heart failure rehospitalization.

Spectrofluorometric determination of hydrogen peroxide based on oxidative catalytic reactions of p-hydroxyphenyl derivatives with metal complexes of thiacalix[4]arenetetrasulfonate on a modified anion-exchanger.

The peroxidase-like catalytic activity of metal complexes of thiacalix[4]arenetetrasulfonate (TCAS[4]) on a modified anion-exchanger (Me(n+)-TCAS[4]A-500; Me(n+) = H2, Fe3+, Fe2+, Mn3+, Co3+, Co2+, Cu2+, Zn2+, Ni2+) for the oxidation of p-hydroxyphenyl derivatives to produce fluorescent substances in the presence of hydrogen peroxide has been investigated. Among the Me(n+)-TCAS[4]A-500 tested, Fe(3+)-TCAS[4]A-500 exhibited the highest level of catalytic activity for the oxidation of p-acetoamidophenol in a carbonate buffer solution of pH 10. The catalytic activity of Fe(3+)-TCAS[4]A-500 was then used for the spectrofluorometric determination of hydrogen peroxide. The calibration curve for the Fe(3+)-TCAS[4]A-500 method was linear over a range spanning from 0.1 to 5.0 microg of hydrogen peroxide in a 1.0 ml sample solution.

Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia.

We investigated the significance of the platelet indices, mean platelet volume (MPV), platelet size deviation width (PDW), and platelet-large cell ratio (P-LCR), in the diagnosis of thrombocytopenia by comparing these levels in 40 patients with hypo-productive thrombocytopenia (aplastic anaemia; AA) and 39 patients with hyper-destructive thrombocytopenia (immune thrombo-cytopenia; ITP). The sensitivity and specificity of platelet indices to make a diagnosis of ITP were also compared. All platelet indices were significantly higher in ITP than in AA, and platelet indices showed sufficient sensitivity and specificity. The area under the curve (AUC) of the receiver operating characteristics curve of platelet indices was large enough to enable the diagnosis of ITP. P-LCR and PDW had the largest AUCs, which indicated that these values were very reliable for immune thrombocytopenia. Our results suggest that these indices provide clinical information about the underlying conditions of thrombocytopenia. More attention should be paid to these indices in the diagnosis of thrombocytopenia.