August 5, 2013Open Access
NT Pro BNP Plasma Level and Atrial Volume Are Linked to the Severity of Liver Cirrhosis
Key Result
Liver cirrhosis was associated with significantly higher NT pro-BNP plasma levels compared to hypertensive controls (365.2 vs 70.8 pg/ml), correlating with disease severity and left atrial volume.
Study Design
Type
Case-Control (n=86)
Multicenter
No
Structured PICO
Are NT-pro-BNP plasma levels and echocardiographic parameters of cardiac dysfunction increased in patients with liver cirrhosis compared to hypertensive controls?
P
Population
58 hospitalized patients with liver cirrhosis (viral or NAFLD-related), median age 62, 72% men, with normal renal function (mean creatinine 0.9 mg/dl).
C
Comparator
28 hypertensive patients without evidence of liver disease, mean age 60.6, 71% male.
O
Outcome
NT-pro-BNP plasma levels and echocardiographic parameters of cardiac morpho-functional changes (Left atrial volume, left ventricular ejection fraction) upon admissionsurrogate
NT-pro-BNP levels and left atrial volume are significantly elevated in patients with cirrhosis, correlating with disease severity and early cardiac diastolic dysfunction.
Main Result
Absolute Event Rate: 365.2% vs 70.8%
p-value: p=<0.001
Limitations
- Cross-sectional nature unable to identify pathogenic mechanisms linking cardiac dysfunction, NT pro BNP serum levels, and severity of liver disease
- Relatively small number of patients
- Use of diuretics and beta-blockers in cirrhotics and of hypertensive patients as controls could bias results by underestimating cardiac alterations
Abstract
BACKGROUND AND AIMS: Plasma levels of NT-pro-BNP, a natriuretic peptide precursor, are raised in the presence of fluid retention of cardiac origin and can be used as markers of cardiac dysfunction. Recent studies showed high levels of NT pro BNP in patients with cirrhosis. We assessed NT pro-BNP and other parameters of cardiac dysfunction in patients with cirrhosis, with or without ascites, in order to determine whether the behaviour of NT pro BNP is linked to the stage of liver disease or to secondary cardiac dysfunction. METHODS: Fifty eight consecutive hospitalized patients mostly with viral or NAFLD-related cirrhosis were studied. All underwent abdominal ultrasound and upper GI endoscopy. Cardiac morpho-functional changes were evaluated by echocardiography and NT-pro-BNP plasma levels determined upon admission. Twenty-eight hypertensive patients, without evidence of liver disease served as controls. RESULTS: Fifty eight cirrhotic patients (72% men) with a median age of 62 years (11% with mild arterial hypertension and 31% with type 2 diabetes) had a normal renal function (mean creatinine 0.9 mg/dl, range 0.7-1.06). As compared to controls, cirrhotic patients had higher NT pro-BNP plasma levels (365.2±365.2 vs 70.8±70.6 pg/ml; p<0.001). Left atrial volume (LAV) (61.8±26.3 vs 43.5±14.1 ml; p = 0.001), and left ventricular ejection fraction (62.7±6.9 vs. 65.5±4%,; p = 0.05) were also altered in cirrhotic patients that in controls. Patients with F2-F3 oesophageal varices as compared to F0/F1, showed higher e' velocity (0.91±0.23 vs 0.66±0.19 m/s, p<0.001), and accordingly a higher E/A ratio (1.21±0.46 vs 0.89±0.33 m/s., p = 0.006). CONCLUSION: NT-pro-BNP plasma levels are increased proportionally to the stage of chronic liver disease. Advanced cirrhosis and high NT-pro-BNP levels are significantly associated to increased LAV and to signs of cardiac diastolic dysfunction. NT pro-BNP levels could hence be an useful prognostic indicators of early decompensation of cirrhosis.