Inflammation increases NT-proBNP and the NT-proBNP/BNP ratio.
Plasma BNP and NT-proBNP are often regarded as interchangeable parameters in assessing heart failure (HF) severity and prognosis. Renal failure results in disproportionate increases of NT-proBNP and an increased NT-proBNP/BNP ratio. Low kidney function is therefore considered particularly when NT-proBNP is used to assess HF. The purpose of this study was to identify other conditions affecting the NT-proBNP/BNP ratio. We examined the NT-proBNP/BNP ratio, 26 other lab parameters, and clinical factors in 218 patients admitted to the HF ward. In addition to renal function, we also found significant correlations between the NT-proBNP/BNP ratio and inflammation as measured by orosomucoid (r = 0.525, p < 0.0001), CRP (r = 0.333, p < 0.0001), haptoglobulin (r = 0.201, p = 0.02), and alpha1-antitrypsin (r = 0.223, p = 0.01). Reverse correlation was found with transferrin (r = -0.323, p < 0.0001), albumin (r = -0.251, p = 0.003), and S-Fe (r = -0.205, p = 0.02), parameters known to decrease during inflammation. Inflammation increased levels of NT-proBNP more than BNP, resulting in an increased NT-proBNP/BNP ratio. Our findings indicate that NT-proBNP should be evaluated concomitantly with inflammatory status to avoid overestimation of HF severity.
Department of Medicine, Heart Failure Center Medicine, Sahlgrenska University Hospital, c/o Laboratory for Cardioimmunology, Wallenberg Laboratory for Cardiovascular Research, The Sahlgrenska Academy at University of Gothenburg, 413 45 Gothenburg, Sweden.
Juliana
J
Jensen
Li-Ping
LP
Ma
Michael L X
ML
Fu
David
D
Svaninger
Per-Arne
PA
Lundberg
Ola
O
Hammarsten
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D007677:Kidney Function Tests; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain