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Published on: July 25, 2019
B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated
Joana Pimenta1, Cristiana Paulo, André Gomes
1Department of Internal Medicine, Hospital S. João, Porto, Portugal. joanamartinspimenta@gmail.com
Insights
B-type natriuretic peptide (BNP) levels in cirrhosis patients are influenced by cardiac function and other factors. Higher BNP levels predict a greater risk of death within six months for decompensated cirrhosis patients.
Area of Science:
- Cardiology
- Hepatology
- Biomarkers
Background:
- B-type natriuretic peptide (BNP) concentrations are elevated in cirrhosis, potentially due to volume status and cirrhotic cardiomyopathy.
- The prognostic value of BNP in cirrhosis remains largely undetermined.
Purpose of the Study:
- To investigate the relationship between hemodynamic parameters, volaemia (using impedance cardiography), and BNP levels in cirrhotic patients.
- To assess the efficacy of BNP as a prognostic marker for survival in this population.
Main Methods:
- A cohort of 83 patients hospitalized with decompensated cirrhosis underwent impedance cardiography and BNP measurements upon admission.
- Seventy discharged patients were followed for six-month mortality.
Main Results:
- Median BNP levels were 130.3 pg/ml. Cardiac output, age, and hemoglobin independently predicted BNP levels.
- Patients with cardiac systolic dysfunction exhibited significantly higher BNP levels (230.8 pg/ml vs. 98.5 pg/ml).
- Elevated BNP levels (above median) were associated with increased six-month mortality (P=0.023), and BNP independently predicted survival (HR=2.86).
Conclusions:
- BNP levels in cirrhosis are influenced by cardiac systolic function and non-cardiac factors, requiring careful interpretation.
- BNP serves as an independent predictor of medium-term survival in advanced cirrhosis, aiding in risk stratification.
Background:
B-type natriuretic peptide (BNP) concentrations are high in cirrhosis, possibly related to volume status and cirrhotic cardiomyopathy. The prognostic significance of BNP in cirrhosis is unknown.
Aims:
We aimed to evaluate (i) the influence of haemodynamic parameters and volaemia, assessed by impedance cardiography (ICG), in BNP levels, (ii) the performance of BNP as a prognostic marker, in a cohort of cirrhotic patients.
Methods:
Patients consecutively hospitalized with decompensated cirrhosis during 1 year were evaluated. At admission, ICG and BNP measurements were performed in 83 patients (median age 56 years; median Child-Pugh score=10). The 70 patients discharged were followed for the occurrence of death within 6 months.
Results:
Median BNP levels were 130.3 (65.2-363.3) pg/ml. Independent BNP predictors in multivariate linear regression analysis were cardiac output, age and haemoglobin (R(2)=36.7%). The 24 patients with cardiac systolic dysfunction, defined by low cardiac output, had higher BNP concentrations than the other patients (230.8 vs 98.5 pg/ml, P=0.003). BNP levels above median were associated with an increased occurrence of death within 6 months of discharge (log rank P=0.023). Cardiac output and BNP were predictors of survival in univariate Cox regression analysis. Only BNP remained independently related to the outcome in multivariate analysis [hazard ratio=2.86 (1.11-7.38), P=0.03].
Conclusions:
BNP levels in cirrhosis reflect cardiac systolic function and non-cardiac variables that should be considered in their interpretation. BNP is an independent predictor of medium-term survival in advanced cirrhosis, suggesting its utility in risk stratification of decompensated cirrhotic patients.
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