Klein Hesselink, E.N. (2013) N-terminal pro-brain natriuretic peptide as a predictor of cardiovascular events and mortality in patients with differentiated thyroid carcinoma. thesis, Medicine.
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Abstract
Introduction: Differentiated thyroid carcinoma (DTC) has a favorable survival rate. Long-term treatment with thyroid hormone is however associated with an increased risk of cardiovascular disease. N-terminal pro-brain natriuretic peptide (NT-proBNP) has been shown to be an excellent predictor for future cardiovascular events and mortality in several populations. Primary aim was to study NT-proBNP as an independent predictor for cardiovascular events, secondary aim was to study the predictive value of NT-proBNP for all-cause mortality in DTC patients in follow-up. Tertiary aim was to determine the optimal NT-proBNP cutoff value to discriminate between DTC patients at high or low risk for cardiovascular events and mortality. Patients and Methods: In this retrospective cohort study, a single center cohort of 288 patients in follow-up for DTC was included. NT-proBNP levels were determined in serum samples dating from 2004-2008. At the end of follow-up in 2012, cardiovascular events and death causes that occurred during follow-up were scored. Using Cox regression analyses, NT-proBNP was studied as an independent predictor for outcome. ROC curves were plotted and sensitivity and specificity were calculated to search for the optimal NT-proBNP cutoff values. Results: Mean baseline age (±SD) was 54.8±14.5 years, median [IQR] NT-proBNP at baseline was 69 [40-119] pg/ml. Median [IQR] follow-up was 6.2 [4.9 – 6.5] years. During follow-up 25 patients (8.7%) had a cardiovascular event, 29 patients (10.1%) died. In crude Cox regression analyses, each SD increase in logarithmically transformed NT-proBNP was associated with a hazard ratio (HR) of 3.0 (95% CI 2.2 – 4.0) for cardiovascular events and HR 3.1 (95% CI 2.2 – 4.3) for mortality. After a backward Cox regression analysis, initially adjustment for age, sex, cardiovascular risk factors and DTC characteristics, HR was 3.3 (95% CI 2.3 – 4.5) for cardiovascular events and 1.9 (95% CI 1.3 – 2.9) for mortality. When NT-proBNP was added to conventional risk factors in the Cox regression model, the predictive model significantly improved for both cardiovascular events (p=0.0003) and mortality (p=0.018). The optimal NT-proBNP cutoff value was found to be 138 pg/ml for cardiovascular events and 85 pg/ml for mortality. Conclusion: NT-proBNP is an independent predictor of cardiovascular events and mortality for patients in follow-up for DTC. NT-proBNP improves risk stratification in DTC patients. Adding NT-proBNP to traditional cardiovascular risk factors in a new model may help to identify patients eligible for a more stringent treatment of cardiovascular risk factors. Further study is needed to establish whether treatment according to risk assessment by the new model can improve event-free survival in these patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Lefrandt, Dr. J.D. and Links, Prof. Dr. T.P. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/691 |
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