B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis

Authors

  • Joana Pimenta,

    1. Department of Internal Medicine, Hospital S. João, Porto, Portugal
    2. Unit of Cardiovascular Research & Development, University of Porto Medical School, Porto, Portugal
    Search for more papers by this author
  • Cristiana Paulo,

    1. Department of Internal Medicine, Hospital S. João, Porto, Portugal
    2. Unit of Cardiovascular Research & Development, University of Porto Medical School, Porto, Portugal
    Search for more papers by this author
  • André Gomes,

    1. Department of Internal Medicine, Hospital S. João, Porto, Portugal
    Search for more papers by this author
  • Sérgio Silva,

    1. Department of Internal Medicine, Hospital S. João, Porto, Portugal
    Search for more papers by this author
  • Francisco Rocha-Gonçalves,

    1. Unit of Cardiovascular Research & Development, University of Porto Medical School, Porto, Portugal
    2. Department of Cardiology, Hospital S. João, Porto, Portugal
    Search for more papers by this author
  • Paulo Bettencourt

    1. Department of Internal Medicine, Hospital S. João, Porto, Portugal
    2. Unit of Cardiovascular Research & Development, University of Porto Medical School, Porto, Portugal
    Search for more papers by this author

Correspondence
Joana Lídia Martins Pimenta, Unidade de Investigação e Desenvolvimento Cardiovascular do Porto, Faculdade de Medicina do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
Tel: +351 917 732 031
Fax: +351 225 513 680
e-mail: joanamartinspimenta@gmail.com

Abstract

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 (R2=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.

Ancillary