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Correlates and Predictors of NT-proBNP in Life Insurance Applicants
Steven J Rigatti1, Robert Stout2
1Rigatti - Founder, Rigatti Risk Analytics, LLC, Consultant Medical Director, Clinical Reference Laboratories, Lenexa KS.
Journal of Insurance Medicine (New York, N.Y.)
|September 19, 2023
Summary
NT-proBNP levels in life insurance applicants are influenced by age, albumin, and kidney function (eGFR). A prediction model using these factors explained 24.7% of NT-proBNP variance, highlighting albumin
Area of Science:
- Biochemistry
- Cardiovascular Diagnostics
- Biostatistics
Background:
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker used in cardiovascular risk assessment.
- Understanding factors influencing NT-proBNP levels is crucial for accurate interpretation in diverse populations.
- Life insurance applicants represent a large, relatively healthy cohort for studying biomarker correlates.
Purpose of the Study:
- To identify laboratory and demographic/historical factors associated with NT-proBNP levels in life insurance applicants.
- To develop and evaluate a predictive model for NT-proBNP using readily available variables.
- To investigate the impact of albumin and estimated glomerular filtration rate (eGFR) on NT-proBNP.
Main Methods:
- Analysis of NT-proBNP blood test results from 1.34 million life insurance applicants aged 50-85.
- Exploratory data analysis to correlate NT-proBNP with laboratory variables, demographics, and medical history.
- Development of predictive models (MARS and OLS) to assess the variance explained by selected predictors.
Main Results:
- NT-proBNP showed expected negative correlation with eGFR and positive correlation with heart disease/hypertension history.
- An unexpected strong negative correlation was found between NT-proBNP and albumin levels.
- A predictive model identified age, albumin, and eGFR as key predictors, explaining 24.7% of NT-proBNP variance (R-squared).
Conclusions:
- NT-proBNP reference ranges can vary significantly based on individual factors like albumin and eGFR.
- Albumin concentration is a significant, albeit poorly understood, negative correlate of NT-proBNP levels.
- These findings emphasize the need to consider multiple variables for accurate NT-proBNP interpretation.
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