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

• Published in: Liver international 2010-08, Vol.30 (7), p.1059-1066
• Main Authors: Pimenta, Joana, Paulo, Cristiana, Gomes, André, Silva, Sérgio, Rocha-Gonçalves, Francisco, Bettencourt, Paulo
• Format: Article
• Language: English
• Subjects: Age Factors; B-type natriuretic peptide; Biomarkers - blood; Cardiac Output; Cardiography, Impedance; Case-Control Studies; Chi-Square Distribution; cirrhosis; Heart Diseases - blood; Heart Diseases - etiology; Heart Diseases - mortality; Heart Diseases - physiopathology; Hemoglobins - metabolism; Hospitalization; Humans; impedance cardiography; Inpatients; Kaplan-Meier Estimate; Linear Models; Liver Cirrhosis - blood; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver Cirrhosis - physiopathology; Middle Aged; Natriuretic Peptide, Brain - blood; Portugal; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Vascular Resistance
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/j.1478-3231.2010.02266.x

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.