Diagnostic and prognostic value of NT-proBNP in patients with non-alcoholic fatty liver disease and acute decompensated heart failure

Misan I.A.: Department of Internal Medicine, Medical Institute, Russian Peoples

Arisheva O.S.: Peoples' Friendship University of Russia

Garmash I.V.: Peoples' Friendship University of Russia

Galochkin S.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Khutsishvili N.: Russian People’s Friendship University (RUDN University), Moscow, Russia

Kobalava Zh.D.: Peoples Friendship University of Russia (PFUR), Vinogradov City Clinical Hospital, Moscow, Russia

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Summary

Aim

To study N-terminal pro-brain natriuretic peptide (NTproBNP) levels in patients with non-alcoholic fatty liver disease (NAFLD) and acute decompensated heart failure (ADHF) and to evaluate its impact on clinical outcomes.

Material and methods

In a prospective single center study, we enrolled 566 patients hospitalized with ADHF (49.3% males, mean age 72.4±11.4 years). NT-proBNP levels were measured upon admission and at discharge from the hospital. Liver steatosis was evaluated by Fibroscan 502 Touch device (Echosens, France) using the CAP ultrasound option. CAP values were analyzed as follows: less than 294 dB/m – grade 0 steatosis (S0), 295-309 dB/m – grade 1 (S1), 310-330 dB/m – grade 2 (S2), ≥331 dB/m – grade 3 (S3). During the follow-up period, all-cause mortality and readmission rates were assessed.

Results

NAFLD was diagnosed in 168 (29.7%) of 566 patients with ADHF. In patients with preserved left ventricular ejection fraction (EF), it occurred more frequently (43%) than in patients with reduced EF (25%). In patients with severe steatosis (S3), the median NT-proBNP level was significantly lower than in patients with moderate steatosis (S1, S2) and without steatosis (S0) both at admission (926, 1246 and 1850 pg/mL, respectively, p <0.001) and at discharge (480, 1077 and 1685 pg/mL, p<0.001). By multivariate Cox regression analysis, NT-proBNP >1593 pg/mL at discharge and left ventricle ejection fraction <40% were independently associated with a higher risk of death from any cause during follow-up (odds ratio 3.14; 95% confidence interval 1.52–6.43; p<0.001, and 2.90; 1.46–5.76; p=0.002, respectively).

Conclusion

Patients with NAFLD and ADHF had lower NT-proBNP values both upon admission and at discharge. NTproBNP and left ventricle ejection fraction in this group of patients predicted the risk of death from any cause.

Key words

Decompensation of chronic heart failure, NTproBNP, non-alcoholic fatty liver disease, prevalence, mortality, prognosis.