NT-proBNP as a Prognostic Marker in Critically Ill Indian Patients: A Retrospective Observational Study from a Tertiary Care Center in North India
Ashwarya Gupta, Ravi Kant, Mukesh Bairwa, Rifika Bansal, Balachandra Routhu
Keywords :
Critical care, Intensive care unit, N-terminal pro-B-type natriuretic peptide, Prognosis
Citation Information :
Gupta A, Kant R, Bairwa M, Bansal R, Routhu B. NT-proBNP as a Prognostic Marker in Critically Ill Indian Patients: A Retrospective Observational Study from a Tertiary Care Center in North India. Bengal Physician Journal 2025; 12 (1):19-23.
Aims and background: Data on the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for critically ill patients are conflicting. This study aimed to investigate the prognostic value of NT-proBNP in critically ill Indian patients.
Materials and methods: This was a retrospective, record-based, observational study conducted in the medicine intensive care unit (ICU) of All India Institute of Medical Sciences, Rishikesh, from December 2023 to May 2024. All patients admitted to the medicine ICU during the study period were eligible for the study. Exclusion criteria included medicolegal cases, age < 18 or >80 years, and patients with missing baseline data. The NT-proBNP was measured on admission. The Mann−Whitney U-test was used to compare ranks, and the receiver operating characteristic curve was used to determine the area under the curve (AUC) and identify the best cut-off values to predict mortality.
Results: A total of 137 participants were eligible for the study. The NT-proBNP levels were higher in nonsurvivors compared with survivors, but the difference was not significant (p = 0.121). However, in a subgroup of patients without heart failure and in another subgroup without renal failure, a significant difference was seen in the NT-proBNP values between survivors and nonsurvivors (p = 0.044 and 0.002, respectively). The AUC for predicting mortality was 0.57.
Conclusion: The NT-proBNP measured at admission was predictive of in-hospital mortality in nonselective critically ill patients without heart failure and in a subgroup of patients without renal involvement.
Weber M, Hamm C. Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart 2006;92(6):843–849. DOI: 10.1136/hrt.2005.071233.
Ventetuolo CE, Levy MM. Cardiac biomarkers in the critically ill. Crit Care Clin 2011;27(2):327–343. DOI: 10.1016/j.ccc.2010.12.004.
Welsh P, Campbell RT, Mooney L, et al. Reference ranges for NT-proBNP (N-terminal pro-B-type natriuretic peptide) and risk factors for higher NT-proBNP concentrations in a large general population cohort. Circ Heart Fail 2022;15(10):e009427. DOI: 10.1161/CIRCHEARTFAILURE.121.009427.
Chaikijurajai T, Demirjian S, Tang WHW. Prognostic value of natriuretic peptide levels for adverse renal outcomes in patients with moderate to severe acute kidney injury with or without heart failure. J Am Heart Assoc 2023;12(21):e031453. DOI: 10.1161/JAHA.123.031453.
Rørth R, Jhund PS, Yilmaz MB, et al. Comparison of BNP and NT-proBNP in patients with heart failure and reduced ejection fraction. Circ Heart Fail 2020;13(2):e006541. DOI: 10.1161/CIRCHEARTFAILURE.119.00 6541.
Ibrahim NE, Januzzi JL. Established and emerging roles of biomarkers in heart failure. Circ Res 2018;123(5):614–629. DOI: 10.1161/CIRCRESAHA.118.312706.
Phua J, Lim TK, Lee KH. B-type natriuretic peptide: Issues for the intensivist and pulmonologist. Crit Care Med 2005;33(9):2094−2113. DOI: 10.1097/01.ccm.0000178351.03327.9f.
Noveanu M, Mebazaa A, Mueller C. Cardiovascular biomarkers in the ICU. Curr Opin Crit Care 2009;15(5):377–383. DOI: 10.1097/MCC.0b013e32832e9705.
Post F, Weilemann LS, Messow CM, et al. B-type natriuretic peptide as a marker for sepsis-induced myocardial depression in intensive care patients. Crit Care Med 2008;36(11):3030–3037. DOI: 10.1097/CCM.0b013e31818b9153.
Coquet I, Darmon M, Doise JM, et al. Performance of N-terminal-pro-B-type natriuretic peptide in critically ill patients: A prospective observational cohort study. Crit Care 2008;12(6):R137. DOI: 10.1186/cc7110.
Almog Y, Novack V, Megralishvili R, et al. Plasma level of N-terminal pro-brain natriuretic peptide as a prognostic marker in critically ill patients. Anesth Analg 2006;102(6):1809–1815. DOI: 10.1213/01.ane.0000217202.55909.5d.
Januzzi JL, Morss A, Tung R, et al. Natriuretic peptide testing for the evaluation of critically ill patients with shock in the intensive care unit: A prospective cohort study. Crit Care 2006;10(1):R37. DOI: 10.1186/cc4839.
Bhatia MS, Sharda SC, Attri R, et al. Correlation of mortality with Pro-BNP and precipitating factors of acute heart failure in patients presenting to a medical emergency of tertiary care hospital: An observational study from North India. Eur Rev Med Pharmacol Sci 2022;26(18):6459–6468. DOI: 10.26355/eurrev_202209_29745.
Reshmi K, Oommen MS, Belgundi P, et al. Prognostic role of N-terminal prohormone of brain natriuretic peptide for patients in the medical intensive care unit with severe sepsis. Lung India 2021;38(5):438–441. DOI: 10.4103/lungindia.lungindia_138_20.
Naveen V, Vengamma B, Mohan A, et al. N-terminal pro-brain natriuretic peptide levels and short term prognosis in acute ischemic stroke. Ann Indian Acad Neurol 2015;18(4):435–440. DOI: 10.4103/0972-2327.165478.
Rudiger A, Gasser S, Fischler M, et al. Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit Care Med 2006;34(8):2140–2144. DOI: 10.1097/01.CCM.0000229144.97624.90.
Charpentier J, Luyt CE, Fulla Y, et al. Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis. Crit Care Med 2004;32(3):660–665. DOI: 10.1097/01.ccm.0000114827.93410.d8.
Vallabhajosyula S, Jentzer JC, Geske JB, et al. New-onset heart failure and mortality in hospital survivors of sepsis-related left ventricular dysfunction. Shock 2018;49(2):144–149. DOI: 10.1097/SHK.0000000000000952.
Meyer B, Huelsmann M, Wexberg P, et al. N-terminal pro-B-type natriuretic peptide is an independent predictor of outcome in an unselected cohort of critically ill patients. Crit Care Med 2007;35(10):2268–2273. DOI: 10.1097/01.CCM.0000284509.23439.5B.
Kotanidou A, Karsaliakos P, Tzanela M, et al. Prognostic importance of increased plasma amino-terminal pro-brain natriuretic peptide levels in a large noncardiac, general intensive care unit population. Shock 2009;31(4):342–347. DOI: 10.1097/SHK.0b013e31818635b6.
Okkonen M, Varpula M, Linko R, et al. N-terminal-pro-BNP in critically ill patients with acute respiratory failure: A prospective cohort study. Acta Anaesthesiol Scand 2011;55(6):749–757. DOI: 10.1111/j.1399-6576.2011.02439.x.