Abstract 10271: Correlates and Prognostic Significance of B-Type Natriuretic Peptide in Patients with Sickle Cell Hemoglobinopathies

Abstract

Introduction: Natriuretic peptides (NP) are hormones released from the heart in response to cardiac stress. Sickle cell hemoglobinopathies are conditions with increased cardiovascular stress, yet few studies have examined determinants of and the relative prognostic significance of NP levels in these patients. Hypothesis: We assessed the hypothesis that plasma B-type NP (BNP) level is one of the strongest independent predictors of death among patients with sickle cell hemoglobinopathies. Methods: From the Vanderbilt University Medical Center electronic health record, we retrospectively studied adult patients with sickle cell disease (SCD, n = 278; median age 30 years, 50% female) and sickle trait (ST, n = 196; median age 45 years, 73% female) in whom BNP was clinically measured from 2003-2020. The association between BNP and risk of death was assessed with multivariable Cox regression. Correlates of BNP levels were examined in multivariable ordinal logistic regression. Results: Over 1846 person-years of follow-up, 43 (9%) patients died. BNP, age, and lactate dehydrogenase levels were the three strongest predictors of death, accounting for 29%, 18%, and 13% of the explained variance in the risk of death, respectively. Each 110 pg/ml greater BNP was associated with a 5% (95% CI: 4-6%) increased risk of death. SCD was associated with a 19% (95% CI: 5 to 36%) increased risk of death compared to ST. Among patients with SCD, significant correlates of BNP ranked by strength of association were hemoglobin, white blood cell count, age, pulmonary artery systolic pressure (PASP), hypertension, left ventricular ejection fraction (LVEF), and neutrophil count (Figure). For patients with ST, the strongest correlates of BNP were PASP, hemoglobin, stroke, age, diabetes, and LVEF. Conclusions: In conclusion, BNP is the strongest predictor of death independent of anemia severity and other features of cardiac structure and function among patients with sickle cell hemoglobinopathies.