The Value of NT-ProBNP in Combination with WBC, PLT, and D-Dimer for Assessing the Severity of Heart Failure Patients

Q: What are the key findings of this study?

Elevated NT-ProBNP was independently associated with functional class III-IV heart failure, while adding WBC, PLT, and D-Dimer did not improve discrimination.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=198). Intervention: Elevated NT-ProBNP (alone or combined with WBC, PLT, and D-Dimer) vs. NYHA class I-II vs NYHA class III-IV (or NT-ProBNP alone). Primary outcome: Association with and prediction of NYHA class III-IV heart failure severity (OR 1.000, 95% CI 1.000 - 1.000, p=0.035).

Q: What does this research mean for the field?

Elevated NT-ProBNP is independently associated with NYHA class III-IV heart failure, but adding WBC, PLT, and D-dimer does not improve discrimination over NT-ProBNP alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jun He; Qianping Xu; Chunjiao Nong; Xiangbing Zou; Yonghao Chen

doi:10.4236/ns.2026.1811016

January 1, 2026Natural ScienceOpen Access

The Value of NT-ProBNP in Combination with WBC, PLT, and D-Dimer for Assessing the Severity of Heart Failure Patients

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Key result

Adding WBC, PLT, and D-dimer to NT-proBNP fails to improve severe heart failure discrimination.

OR 1.000
95% CI 1.000 - 1.000
P=0.035
n=198

Why the study?

The value of combined detection of NT-ProBNP, WBC, PLT, and D-Dimer in evaluating the severity of patients with heart failure needed to be explored.

Does the combined detection of NT-ProBNP, WBC, PLT, and D-Dimer improve the discrimination of heart failure severity (NYHA class III-IV) compared to NT-ProBNP alone in hospitalized patients with heart failure?

Key Points

To evaluate whether combining NT-ProBNP with white blood cell count, platelet count, and D-dimer improves the assessment of heart failure severity compared with NT-ProBNP alone.
Retrospective analysis of 198 patients with heart failure admitted to a single hospital between January 2024 and June 2025.
Patients were stratified into NYHA class I-II (n = 59) and NYHA class III-IV (n = 139) groups, with fasting venous NT-ProBNP, WBC, PLT, and D-Dimer measured on admission.
Multivariate logistic regression identified independent severity factors, and ROC curve analysis evaluated the diagnostic accuracy of single and combined biomarkers.
Elevated NT-ProBNP was independently associated with NYHA class III-IV (OR = 1.000, 95% CI: 1.000 - 1.000, P = 0.035), whereas WBC, PLT, and D-Dimer were not independent risk factors (P > 0.05).
NT-ProBNP alone predicted heart failure severity with an AUC of 0.663 (95% CI: 0.592 - 0.734), sensitivity of 54.33%, specificity of 73.47%, and an optimal cut-off value of 7663.00 pg/ml.
The combined panel of NT-ProBNP, WBC, PLT, and D-Dimer yielded an identical AUC of 0.663 (95% CI: 0.594 - 0.732) with 56.36% sensitivity and 74.36% specificity, demonstrating no improvement in discrimination over NT-ProBNP alone.

Study Design

Type

Observational (n=198)

Multicenter

No

Structured PICO

Does the combined detection of NT-ProBNP, WBC, PLT, and D-Dimer improve the discrimination of heart failure severity (NYHA class III-IV) compared to NT-ProBNP alone in hospitalized patients with heart failure?

P

Population

198 hospitalized adults with heart failure in China (34.8% female; 59 NYHA class I-II, 139 NYHA class III-IV), free of acute myocardial infarction, malignancy, severe infection, or autoimmune disease.

E

Exposure

Combined detection panel of N-terminal pro-B-type natriuretic peptide (NT-ProBNP), white blood cell count (WBC), platelet count (PLT), and D-Dimer measured in fasting peripheral venous blood at hospital admission

C

Comparator

Single-marker detection of NT-ProBNP alone (and individual detection of WBC, PLT, and D-Dimer)

O

Outcome

Predictive and discriminatory accuracy for heart failure severity (defined as NYHA functional class III-IV vs. class I-II at hospital admission, assessed independently by two board-certified cardiologists) evaluated via ROC curve area under the curve (AUC), sensitivity, and specificitysurrogate

Main Result

Odds Ratio: 1 (95% CI 1–1)

Absolute Event Rate: 8354.67% vs 4284%

p-value: p=0.035

Adding routine hematologic and coagulation markers (WBC, PLT, D-Dimer) to NT-ProBNP does not improve diagnostic discrimination for heart failure severity (NYHA class III-IV vs. I-II) compared to NT-ProBNP alone.

Limitations

Single-center retrospective study with a limited sample size, restricting generalizability
Performance estimates were derived from the development cohort without internal or external validation
Novel cardiac biomarkers such as high-sensitivity cardiac troponin I (hs-cTnI) and growth-differentiation factor-15 (GDF-15) were not incorporated
Discrepancies noted by authors regarding non-integer sensitivity/specificity denominators and the visual ROC curve for WBC versus its tabulated AUC
Single-center retrospective study
Limited sample size
Performance estimates were derived from the development cohort without internal validation (e.g., bootstrapping or cross-validation) or external validation
Discrepancy between the WBC AUC reported in Table 3 (0.385) and the visual representation in Figure 1 (approximating 0.500), as well as sensitivity/specificity percentages not corresponding to integer classification counts

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Implication

NT-proBNP alone offers modest discrimination for severe HF without added value from inflammatory markers; leaves open whether multi-marker panels warrant prospective validation.

Abstract

Objective: To explore the value of combined detection of N-terminal pro-B-type natriuretic peptide (NT-ProBNP), white blood cell count (WBC), platelet count (PLT) and D-dimer (D-Dimer) in evaluating the severity of patients with heart failure. Methods: A retrospective study was conducted. A total of 198 patients diagnosed with heart failure who received treatment in Guangxi-ASEAN Economic and Technological Development Zone People’s Hospital (Nanning Tenth People’s Hospital) from January 2024 to June 2025 were enrolled. According to the New York Heart Association (NYHA) cardiac functional classification, patients were divided into NYHA class I-II group (59 cases) and NYHA class III-IV group (139 cases). The differences in levels of NT-ProBNP, WBC, PLT, D-Dimer and other indicators between the two groups were compared. Multivariate logistic regression analysis was applied to identify influencing factors for increased severity of heart failure. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of single-indicator detection and combined-indicator detection for heart failure severity. Results: The NT-ProBNP level in patients of NYHA class III-IV group was significantly higher than that in NYHA class I-II group, with statistically significant difference (P < 0.001). Multivariate logistic regression analysis showed that elevated NT-ProBNP level was independently associated with NYHA class III-IV (OR = 1.000, 95% CI: 1.000 - 1.000, P < 0.05). ROC curve analysis revealed that the area under curve (AUC) of NT-ProBNP for predicting heart failure severity was 0.663, with a sensitivity of 54.33% and specificity of 73.47%. The AUC of combined detection was 0.663, with sensitivity of 56.36% and specificity of 74.36%. Conclusion: Elevated NT-ProBNP level is independently associated with NYHA class III-IV in patients with heart failure. The addition of WBC, PLT and D-Dimer to NT-ProBNP did not demonstrate improved discrimination over NT-ProBNP alone, as both approaches achieved an identical AUC of 0.663. Small differences in sensitivity and specificity at separately selected thresholds do not establish superiority or justify routine clinical adoption of the combined panel.

Discussion

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Cite This Study

He et al. (2026) conducted an observational in Heart failure (n=198). Elevated NT-ProBNP (alone or combined with WBC, PLT, and D-Dimer) vs. NYHA class I-II vs NYHA class III-IV (or NT-ProBNP alone) was evaluated on Association with and prediction of NYHA class III-IV heart failure severity (OR 1.000, 95% CI 1.000 - 1.000, p=0.035). Elevated NT-ProBNP was independently associated with functional class III-IV heart failure, while adding WBC, PLT, and D-Dimer did not improve discrimination.

synapsesocial.com/papers/6af5bf07e94012e8747ad994 https://doi.org/10.4236/ns.2026.1811016

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The Value of NT-ProBNP in Combination with WBC, PLT, and D-Dimer for Assessing the Severity of Heart Failure Patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Value of NT-ProBNP in Combination with WBC, PLT, and D-Dimer for Assessing the Severity of Heart Failure Patients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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