B-Type Natriuretic Peptide Predict Mortality in Diabetic Patients with Foot Ulcer

The background of this article is to retrospectively investigate the role of B-type natriuretic peptide (BNP) levels as an independent prognostic marker for mortality in diabetic patients with foot ulcer. In the period 1 January-30 June 2009, 279 diabetic patients were admitted to our foot center because of foot ulcer: neuroischemic in 182 (65.2%), neuropathic in 97 (34.8%), infected in 233 (83.5%). In all patients BNP (normal value: ≤ 100 pg/mL) was evaluated at admission. Mortality from any cause was established and the relationship between the recorded variables and risk of death was evaluated by the survival Cox regression model. Kaplan-Meier analysis was performed. BNP was >100 pg/mL in 167 (59.9%) patients. 278 (99.6%) patients were followed to December 31, 2012 with a mean follow-up of 3.6 ± 0.2 years. Seventy-one/278 (25.5%) patients died. Of these, 61 (85.9%) had a BNP value >100 pg/mL. Forty-five/71 (63.4%) patients died from cardiac cause. The most frequent cause of death was heart disease: 45/71 (63.4%). Of these, 24 patients had no history of CAD. Multivariate analysis showed the independent predictors of death to be BNP > 100 (hazard ratio 6.040; p <0.001; CI, 2.380-15.328), age (hazard ratio 1.043, p = 0.024, CI 1.001-1.082), and dialysis treatment (hazard ratio 3.145; p = 0.032; CI, 1.100-8.988).