939 B-Type Natriuretic Peptide Predicts 90-Day Mortality and Need for Paracentesis in Patients With Cirrhosis and Without Systolic Heart Failure

Abstract

INTRODUCTION: Fluid overload is the most frequent complication of end-stage liver disease, regardless of its etiology. Levels of brain natriuretic peptide (BNP) have been shown to be elevated in cirrhotic patients when matched to healthy subjects. There are only small observational studies done in Asian and European populations evaluating the role of BNP in predicting mortality of patients with liver disease. The use of BNP to predict 90-day requirement of paracentesis has not been studied. METHODS: Retrospective analysis of medical records of patients with a diagnosis of cirrhosis without heart failure, arrhythmia, coronary artery disease or pulmonary hypertension from John H. Stroger Hospital of Cook County Medical Record's database from 2008 to 2018. IRB approval was obtained. All analysis was done using STATAv14. RESULTS: The cohort included 430 patients with clinical and radiological diagnosis of cirrhosis without systolic dysfunction of which 12% had BNP ≥ 300 pg/mL. Patients with BNP ≥ 300 pg/mL were younger (53.3 vs 55.6 years, P = 0.027), had less proportion of hepatitis B (0% vs 100%, P = 0.013), hepatitis C (7.4% vs 92.6%, P = 0.036), higher mean number of paracentesis (1.60 vs 2.52, P = 0.005), creatinine (2.66 vs 1.03 mg/dL, P=< 0.001), bilirubin (5.36 vs 2.84 mg/dL, P=< 0.001) and INR levels (1.75 vs 1.50, P = 0.003). There was no significant difference in Child-Pugh class between the two groups and MELDNa scores were significantly higher in the BNP ≥ 300 pg/mL group. Kaplan-Meier survival estimates for death within 90 days show increased significant mortality [HR 3.49, P = 0.037] and significantly higher requirement for paracentesis in 90 days [HR 2.26, P = 0.020] with levels of BNP ≥ 300 pg/mL. CONCLUSION: This is, to our knowledge, the largest study done to assess BNP as a prognostication tool in cirrhotic patients. Despite excluding patients with overt cardiac dysfunction, we found that higher BNP levels are significantly associated with higher medium-term mortality, paracentesis requirements and higher MELDNa scores, suggesting high BNP values as an indicator of severity. The presence of hepatitis B and C seem to be a protective factor, most likely due to possible less indolent disease and more accessible treatment methods. In conclusion, BNP seems to be a reliable predictor of severity in this cohort of patients.