title: NT-proBNP as a marker of cardiopulmonary status in sickle cell anaemia in Africa.
abstract: N-terminal (NT) pro-brain natriuretic peptide (proBNP) > or =160 ng/l has a 78% positive predictive value for pulmonary hypertension and is associated with increased mortality in US sickle cell disease patients, but the importance in sickle cell disease patients in Africa is not known. In a cross-sectional study at Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria, we studied 133 hydroxycarbamide-naïve Nigerian sickle cell anaemia patients aged 18-52 years at steady-state and 65 healthy controls. Twenty-six percent of patients versus 5% of controls had NT-proBNP > or =160 ng/l (P = 0.0006). By logistic regression among the patients, human immunodeficiency virus seropositivity, higher serum ferritin and lower haemoglobin or higher lactate dehydrogenase independently predicted elevated NT-proBNP. After adjustment for haemoglobin concentration, elevated NT-proBNP concentration was associated with an estimated 7.8-fold increase in the odds of severe functional impairment, defined as an inability to walk more than 300 m in 6 min (95% confidence interval 1.5-32.6; P = 0.005). Similarly, elevated tricuspid regurgitation velocity was associated with an estimated 5.6-fold increase in the odds of functional impairment (95% confidence interval 1.5-21.0; P = 0.011). In conclusion, NT-proBNP elevation is common and is associated with markers of anaemia, inflammation and iron status and with severe functional impairment among sickle cell anaemia patients in Nigeria.
authors.affiliation: Taraba State Specialist Hospital, Jalingo, Nigeria.
authors.forename: Zakari Y
authors.initials: ZY
authors.lastname: Aliyu
authors.forename: Aisha
authors.initials: A
authors.lastname: Suleiman
authors.forename: Ester
authors.initials: E
authors.lastname: Attah
authors.forename: Aisha I
authors.initials: AI
authors.lastname: Mamman
authors.forename: Aliyu
authors.initials: A
authors.lastname: Babadoko
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nouraie
authors.forename: Laurel
authors.initials: L
authors.lastname: Mendelsohn
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kato
authors.forename: Victor R
authors.initials: VR
authors.lastname: Gordeuk
authors.forename: Mark T
authors.initials: MT
authors.lastname: Gladwin
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005080:Exercise Test / Q000379:methods; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D014262:Tricuspid Valve Insufficiency / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D016138:Walking / Q000502:physiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
references.citation: Intern Med J. 2009 Aug;39(8):495-501
references.pmid: 19732197
references.citation: J Am Coll Cardiol. 2007 Jan 30;49(4):472-9
references.pmid: 17258093
references.citation: Blood. 2003 Feb 15;101(4):1257-61
references.pmid: 12393669
references.citation: N Engl J Med. 2005 Feb 17;352(7):666-75
references.pmid: 15716560
references.citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references.pmid: 16376782
references.citation: J Am Soc Echocardiogr. 2002 Feb;15(2):167-84
references.pmid: 11836492
references.citation: J Am Coll Cardiol. 2004 Mar 3;43(5):764-70
references.pmid: 14998614
references.citation: Am J Respir Crit Care Med. 2000 Feb;161(2 Pt 1):487-92
references.pmid: 10673190
references.citation: Haematologica. 2007 Jun;92(6):738-43
references.pmid: 17550845
references.citation: Circulation. 1997 Jul 15;96(2):509-16
references.pmid: 9244219
references.citation: N Engl J Med. 2004 Feb 26;350(9):886-95
references.pmid: 14985486
references.citation: JAMA. 1993 Oct 13;270(14):1702-7
references.pmid: 8411500
references.citation: Am J Med. 2004 Nov 1;117(9):665-9
references.pmid: 15501204
references.citation: Am J Hematol. 2008 Jan;83(1):63-70
references.pmid: 17910044
references.citation: Blood. 2006 Mar 15;107(6):2279-85
references.pmid: 16291595
references.citation: JAMA. 2006 Jul 19;296(3):310-8
references.pmid: 16849664
references.citation: Ann Trop Med Parasitol. 2007 Jan;101(1):3-14
references.pmid: 17244405
references.citation: Genomics. 1996 Apr 15;33(2):167-76
references.pmid: 8660964
references.citation: Circulation. 2005 Dec 6;112(23):3602-7
references.pmid: 16330702
references.citation: Am J Hematol. 2008 Jun;83(6):485-90
references.pmid: 18306362
references.citation: Science. 2002 Dec 13;298(5601):2133-4
references.pmid: 12481120