title: B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) concentrations are high in cirrhosis, possibly related to volume status and cirrhotic cardiomyopathy. The prognostic significance of BNP in cirrhosis is unknown.
  
  
  OBJECTIVE
  We aimed to evaluate (i) the influence of haemodynamic parameters and volaemia, assessed by impedance cardiography (ICG), in BNP levels, (ii) the performance of BNP as a prognostic marker, in a cohort of cirrhotic patients.
  
  
  METHODS
  Patients consecutively hospitalized with decompensated cirrhosis during 1 year were evaluated. At admission, ICG and BNP measurements were performed in 83 patients (median age 56 years; median Child-Pugh score=10). The 70 patients discharged were followed for the occurrence of death within 6 months.
  
  
  RESULTS
  Median BNP levels were 130.3 (65.2-363.3) pg/ml. Independent BNP predictors in multivariate linear regression analysis were cardiac output, age and haemoglobin (R(2)=36.7%). The 24 patients with cardiac systolic dysfunction, defined by low cardiac output, had higher BNP concentrations than the other patients (230.8 vs 98.5 pg/ml, P=0.003). BNP levels above median were associated with an increased occurrence of death within 6 months of discharge (log rank P=0.023). Cardiac output and BNP were predictors of survival in univariate Cox regression analysis. Only BNP remained independently related to the outcome in multivariate analysis [hazard ratio=2.86 (1.11-7.38), P=0.03].
  
  
  CONCLUSIONS
  BNP levels in cirrhosis reflect cardiac systolic function and non-cardiac variables that should be considered in their interpretation. BNP is an independent predictor of medium-term survival in advanced cirrhosis, suggesting its utility in risk stratification of decompensated cirrhotic patients.
authors.affiliation: Department of Internal Medicine, Hospital S. João, Porto, Portugal. joanamartinspimenta@gmail.com
authors.forename: Joana
authors.initials: J
authors.lastname: Pimenta
authors.forename: Cristiana
authors.initials: C
authors.lastname: Paulo
authors.forename: André
authors.initials: A
authors.lastname: Gomes
authors.forename: Sérgio
authors.initials: S
authors.lastname: Silva
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha-Gonçalves
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D002307:Cardiography, Impedance; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D006331:Heart Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011174:Portugal; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014655:Vascular Resistance
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain