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B‐type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis
Author(s) -
Pimenta Joana,
Paulo Cristiana,
Gomes André,
Silva Sérgio,
RochaGonçalves Francisco,
Bettencourt Paulo
Publication year - 2010
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2010.02266.x
Subject(s) - natriuretic peptide , cirrhosis , medicine , cardiology , cardiac function curve , acute decompensated heart failure , gastroenterology , heart failure
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.