The Added Value of Bioimpedance Analysis to NT-proBNP in Predicting Short-term outcome in Acute Heart Failure Patients

Background: Acute heart failure (AHF) is a significant clinical problem, which has a high prevalence, mortality, and rehospitalization. Congestion is critical in the pathogenesis of AHF, which is also a predictor of mortality and rehospitalization in patients with AHF. Objective: Knowing the effect of adding a %Total body water (TBW) test detected by Bioimpedance Analysis to NT-proBNP as a short-term clinical outside predictor of patients with acute heart failure Method: This research is an analytical observational study using prospective cohort methods. The research was conducted at Dr. Saiful Anwar Malang Hospital in January 2018-July 2019 with research subjects taken consecu-tively against all AHF patients hospitalized at RSUD dr. Saiful Anwar Malang. The data were taken in the form of NT-proBNP value during mission and %TBW before the patient leaves the hospital detected with NICaS examination. 90 days follow-up was conducted via phone calls to the patients, to evaluate the patient’s follow-up for cardiovascular death and rehospitalization. Results: This study involved 65 subjects who were on average 61 years old and the majority male. Non-survivor patients had a higher NYHA class, NT-proBNP, and %TBW pre-discharge than the survivor group. Based on a statistical analysis we found that the ROC curve shows NT-proBNP is a good predictor of mortality (HR: AUC 0.74; 95%CI 0.59-0.90) and rehospitalization (HI: AUC 0.88; 95%CI 0.78-0.97). Similarly, %TBW pre-discharge shows good predictors of mortality (HI: AUC 0.72, 95%CI 0.56-0.87) and rehospitalization (HI: AUC 0.83, 95%CI 0.73-0.94). The addition of the %TBW pre-discharge parameter to NT-proBNP results in the best predictor numbers among the three for both mortality (HI: AUC 0.84; 95%CI 0.72-0.96) and rehospitalization (HI: AUC 0.92; 95%CI 0.85-1.00). Conclusion: The addition of pre-discharge %TBW examination detected by a bioimpedance analysis tool to NT-pro BNP at admission, increases the predicted value of short-term clinical outpatient in the form of mortality and rehospitalization of patients with acute heart failure.