Abstract
Background: Natriuretic Peptide (NP) system has emerged as one of the most important hormonal systems in
control of cardiovascular homeostasis. Liver cirrhosis may affect NP levels that were well described in heart failure.
NP prognostic evaluation was well established in many diseases.
Objectives: to measure serum and ascitic NT-proBNP levels in cirrhotic and cardiac Egyptian patients to
diagnose a cut-off value for exclusion of heart failure, to assess if cirrhosis per se may contribute in NT-proBNP
elevation and to assess the contribution of these levels as predictors of mortality in liver cirrhosis.
Patients and methods: A prospective cohort study was conducted in 80 patients (50 cirrhotics and 30 had
heart failure). Serum and ascitic (if available) NT-proBNP were measured. Cirrhotic patients were followed for
1-year. Kaplan-Meier survival analysis was used to evaluate 1-year survival rates. Logistic regression analyses
were performed with 1-year mortality as the dependent variable.
Results: Median serum and ascitic NT-proBNP levels in cirrhotics were 239.4 and 267pg/ml versus 10596.6 and
9771 pg/ml in heart failure patients (P<0.001). Serum and ascitic NT-proBNP cut-off values >1000 pg/ml resulted
in sensitivity of 100% and 93.3% and specificity of 97.8% and 92.5% for exclusion of cardiac disease in cirrhotics.
NT-proBNP was elevated in cirrhotics compared with age matched controls (P<0.001) and significantly correlated
with severity of liver cirrhosis based on Child-Pugh and MELD (P=0.05, P<0.001 respectively). Higher NT-proBNP
associated with increased 1-year mortality. NT-proBNP was an independent predictor for mortality in cirrhotics in
addition to other conventional factors.
Conclusion: NT-pro BNP could be a powerful initial non-invasive diagnostic tool for exclusion of heart disease
in cirrhotic patients. End stage cirrhosis per se may contribute to NT-proBNP elevation. NT-proBNP provided
incremental information in 1-year mortality prediction in decompensated cirrhotics.