Relationship between NT-proBNP and Cardio-Renal Dysfunction in Patients with Advanced Liver Cirrhosis
Background & Aims: ProBNP is a sensitive marker of cardiac dysfunction. We assessed the concentration of circulating NT-proBNP in patients with liver cirrhosis in various stages of the disease and its correlation with markers of cardiac and renal dysfunction and with markers of liver disease severity.
Patients and methods: A number of 88 patients with liver cirrhosis were included in the study, divided into 3 groups: group 1 - 18 control patients without ascites; group 2 - 35 non-azotemic patients with ascites; group 3 - 35 patients with hepatorenal syndrome. The cardiac dysfunction was assessed by measuring the NT-proBNP serum levels and the QTc interval. The markers of renal dysfunction were the estimated glomerular filtration rates - formulas involving creatinine and serum cystatin C. The Child-Pugh score was used to assess the liver disease severity.
Results: The median NT-proBNP serum levels significantly increased in patients with advanced liver cirrhosis (group 3: 960 fmol/ml and group 2: 660 fmol/ml) as compared to group 1 (435 fmol/ml) (p<0.05). A significant direct correlation was found between the NT-proBNP concentration and the QTc interval (r=0.540, p<0.001). The NT-proBNP levels also correlated with the Child-Pugh score (r=0.501, p<0.01), proving the link between the cardiac dysfunction and the liver disease severity. The cardio-renal interrelation is supported by the relationship between the NT-proBNP concentration and the estimated clearances.
Conclusion: The high NT-proBNP levels in patients with advanced cirrhosis indicate the presence of cardiac dysfunction, which has a role in the pathogenesis of the hepatorenal syndrome.
Abbreviations: DP: diastolic pressure; GFR: glomerular filtration rate; HRS: hepatorenal syndrome; MAP:mean arterial pressure; NT-proBNP: N-terminal fragment of the prohormone B-type natriuretic peptide; proBNP: prohormone brain natriuretic peptide; SBP: spontaneous bacterial peritonitis; SP: systolic pressure; TIPS: tranjugular intrahepatic portosystemic shunt.