Study of Serum NT Pro-BNP Levels in Patients with Cirrhosis of Liver

Abstract

Background and Aims: B-type natriuretic peptide (BNP) and its prohormone (pro-BNP) are sensitive markers of ventricular dysfunction and presence of myocardial hypertrophy. Although conventional Doppler echocardiography has been used to assess diastolic filling dynamics, this technique is limited in diagnosing left ventricular diastolic dysfunction and there is no single diagnostic test that can identify patients with cirrhotic cardiomyopathy. This study aimed to assess NT pro-BNP levels in patients with cirrhosis of liver. Methods: 80 patients with cirrhosis of liver were included of which 63 were decompensated (Group A) and 17 were compensated (Group B). Diastolic dysfunction was evaluated by echocardiography and serum NT pro-BNP levels were determined. 20 age- and sex matched patients, without evidence of liver or cardiac disease, were taken as controls (Group C). Results: 80 cirrhotic patients (53: M; 27: F; median age, 45 years) were included. Patients with cirrhosis of liver had significantly higher prevalence of diastolic dysfunction (76% vs 24%; P < 0.002) and higher mean NT pro-BNP levels (358.1 ± 260.5 vs. 125.4 ± 35.3 pg/mL; P < 0.001) compared to controls. NT pro-BNP values were significantly higher in patients with decompensated (Group A: n = 63; 463.3 ± 215.5 pg/mL) than in those with compensated cirrhosis (Group B: n = 17; 253.6 ± 80.7 pg/mL; P < 0.001). NT pro-BNP levels significantly increased as Child-Pugh class increased from A to C. Conclusion: NT pro-BNP values were significantly higher in patients with cirrhosis and diastolic dysfunction compared to those without diastolic dysfunction. NT pro-BNP levels increased as the liver disease severity increased which was evident from significantly raised levels in CTP C patients. NT pro-BNP can be a useful non-operator dependent and early marker of cirrhotic cardiomyopathy.