Prognostic value of extreme NT-proBNP levels in patients hospitalized for heart failure

To evaluate the prognostic value of extreme levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP) measured at any time during hospitalization for heart failure (HF).

A retrospective cohort study including patients hospitalized for HF in a secondary-level hospital with at least one NT-proBNP measurement. Two groups were defined: patients with extreme NT-proBNP levels (>50,000pg/mL) and those with elevated NT-proBNP levels (>1800pg/mL and <20,000pg/mL). The primary outcome was a composite of (1) in-hospital mortality; (2) HF readmission, and (3) 6-month mortality. Cox survival models were used for analysis.

A total of 83 patients with extreme NT-proBNP levels and 100 with elevated NT-proBNP levels were included; 61% were women, with a median age of 87 years. Comorbidity burden was high and similar between groups (median Charlson index: 8). The primary outcome was more frequent in patients with extreme NT-proBNP levels: 25.02 vs. 10.53 events per 100 patient-months (HR 2.07; 95% CI: 1.37-3.14). Both in-hospital and 6-month mortality were significantly higher in the extreme NT-proBNP group, while HF readmissions were numerically higher but not statistically significant. These results remained consistent after multivariable adjustment.

Patients hospitalized for HF with NT-proBNP levels>50,000pg/mL have a worse prognosis than those with NT-proBNP<20,000pg/mL, representing a high-risk subgroup with short-term mortality.