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N-Terminal Pro-Brain Natriuretic Peptide: Prognostic Potential in End Stage Liver Cirrhosis in a Cohort Free of Heart Failure; an Egyptian Insight

Elham Ahmed Hassan, Abeer Sharaf EL-Din Abd El-Rehim, Zain EL-Abdeen Ahmed Sayed, Heba Ahmed Abdelhafez and Muhamad Ramadan Abdelhameed

Background: Natriuretic Peptide (NP) system has emerged as one of the most important hormonal systems in control of cardiovascular homeostasis. Liver cirrhosis may affect NP levels that were well described in heart failure. NP prognostic evaluation was well established in many diseases.

Objectives: to measure serum and ascitic NT-proBNP levels in cirrhotic and cardiac Egyptian patients to diagnose a cut-off value for exclusion of heart failure, to assess if cirrhosis per se may contribute in NT-proBNP elevation and to assess the contribution of these levels as predictors of mortality in liver cirrhosis.

Patients and methods: A prospective cohort study was conducted in 80 patients (50 cirrhotics and 30 had heart failure). Serum and ascitic (if available) NT-proBNP were measured. Cirrhotic patients were followed for 1-year. Kaplan-Meier survival analysis was used to evaluate 1-year survival rates. Logistic regression analyses were performed with 1-year mortality as the dependent variable.

Results: Median serum and ascitic NT-proBNP levels in cirrhotics were 239.4 and 267pg/ml versus 10596.6 and 9771 pg/ml in heart failure patients (P<0.001). Serum and ascitic NT-proBNP cut-off values >1000 pg/ml resulted in sensitivity of 100% and 93.3% and specificity of 97.8% and 92.5% for exclusion of cardiac disease in cirrhotics. NT-proBNP was elevated in cirrhotics compared with age matched controls (P<0.001) and significantly correlated with severity of liver cirrhosis based on Child-Pugh and MELD (P=0.05, P<0.001 respectively). Higher NT-proBNP associated with increased 1-year mortality. NT-proBNP was an independent predictor for mortality in cirrhotics in addition to other conventional factors.

Conclusion: NT-pro BNP could be a powerful initial non-invasive diagnostic tool for exclusion of heart disease in cirrhotic patients. End stage cirrhosis per se may contribute to NT-proBNP elevation. NT-proBNP provided incremental information in 1-year mortality prediction in decompensated cirrhotics.