In the present issue of Critical Care, Noveanu and colleagues evaluated brain natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) serial measurements as predictive of 30-day and 1-year mortality and readmission in patients

colleagues evaluated brain natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) serial measurements as predictive of 30-day and 1-year mortality and readmission in patients admitted to the emergency department for acute decompen sated heart failure (ADHF) [1]. Th e usefulness of measuring BNP and NT-proBNP in the diagnosis and management of congestive heart failure is well known [2,3]. Both BNP and NT-proBNP are useful for diagnosis in patients presenting with undiff erentiated dyspnoea in the emergency department and have been shown to accurately refl ect heart failure severity and prognosis [3-6]. Moreover, in some studies, serial BNP evaluations have been demonstrated to be useful in clinical management [7]. Noveanu and colleagues showed during 1-year followup in a multivariate analysis that BNP at 24 hours (mean 95% confi dence interval) (1.02 (1.01 to 1.04), P = 0.003), at 48 hours (1.04 (1.02 to 1.06), P <0.001) and at discharge (1.02 (1.01 to 1.03), P <0.001) independently predicted 1-year mortality, while only predischarge NT-proBNP was predictive (1.07 (1.01 to 1.13), P = 0.016). Com parable results could be obtained for the secondary endpoint of 30-day mortality but not for 1-year heart failure readmissions. Th ese results from Noveanu and colleagues’ paper are in accordance with data reported by our group [8]. We demonstrated that a reduction of BNP >46% at hospital discharge coupled with a BNP absolute value <300 pg/ml resulted in a very powerful negative prognostic value for future cardiovascular outcomes in patients hospitalised with ADHF [8]. Other studies demonstrated the usefulness of repeated measurements of natriuretic peptides during hospitalisation in predicting survival of ADHF patients [8-11]. BNP variations during hospitalisation could give prognostic information, particularly at discharge, and could also suggest a qualitative variation of treatment (intensifi cation or decrement of drugs) on the basis of natriuretic peptide levels. Noveanu and colleagues have also demonstrated that the prognostic accuracy of BNP was comparable at 24 hours with 48 hours and with discharge [1]. Th e authors suggested that BNP at 24 hours could be suitable to assess prognosis and to vary treatment in order to decrease mortality in patients with constant elevated levels of BNP. Th is suggestion is in accordance again with data from our laboratory, where we showed that a drop of BNP >25% at 24 hours was a strong negative prognostic factor for future cardiovascular events [8], suggesting Abstract