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Inflammation increases NT-proBNP and the NT-proBNP/BNP ratio

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Abstract

Plasma BNP and NT-proBNP are often regarded as interchangeable parameters in assessing heart failure (HF) severity and prognosis. Renal failure results in disproportionate increases of NT-proBNP and an increased NT-proBNP/BNP ratio. Low kidney function is therefore considered particularly when NT-proBNP is used to assess HF. The purpose of this study was to identify other conditions affecting the NT-proBNP/BNP ratio. We examined the NT-proBNP/BNP ratio, 26 other lab parameters, and clinical factors in 218 patients admitted to the HF ward. In addition to renal function, we also found significant correlations between the NT-proBNP/BNP ratio and inflammation as measured by orosomucoid (r = 0.525, p < 0.0001), CRP (r = 0.333, p < 0.0001), haptoglobulin (r = 0.201, p = 0.02), and alpha1-antitrypsin (r = 0.223, p = 0.01). Reverse correlation was found with transferrin (r = −0.323, p < 0.0001), albumin (r = −0.251, p = 0.003), and S–Fe (r = −0.205, p = 0.02), parameters known to decrease during inflammation. Inflammation increased levels of NT-proBNP more than BNP, resulting in an increased NT-proBNP/BNP ratio. Our findings indicate that NT-proBNP should be evaluated concomitantly with inflammatory status to avoid overestimation of HF severity.

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Abbreviations

BNP:

B-type natriuretic peptide

CHF:

Chronic heart failure

CV:

Coefficient of variation

NT-proBNP:

N-terminal pro B-type natriuretic peptide

eGFR:

Estimated glomerular filtration rate

HF:

Heart failure

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Acknowledgments

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. We would like to thank the Swedish Research Council (M.L.X.F., O.H.), Swedish Heart-Lung Foundation (M.L.X.F.), Swedish Cancer Society (O.H.), the Swedish Pain Foundation (O.H.), and the Department of Laboratory Medicine at Sahlgren’s University Hospital Foundation (O.H.) for grant support. We also acknowledge Max Pertzold for data analysis, and Hans Herlitz for recruiting patients from the Department of Renal Diseases.

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Authors and Affiliations

  1. Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden

    David Svaninger, Per-Arne Lundberg & Ola Hammarsten

  2. Department of Medicine, Heart Failure Center Medicine, Sahlgrenska University Hospital, c/o Laboratory for Cardioimmunology, Wallenberg Laboratory for Cardiovascular Research, The Sahlgrenska Academy at University of Gothenburg, 413 45, Gothenburg, Sweden

    Juliana Jensen, Li-Ping Ma & Michael L. X. Fu

  3. Department of Cardiology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China

    Li-Ping Ma

  4. Department of Clinical Chemistry, Sahlgren’s University Hospital, University of Goteborg, Bruna straket 16, 413 45, Gothenburg, Sweden

    Ola Hammarsten

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  1. Juliana Jensen
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Correspondence to Ola Hammarsten.

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Jensen, J., Ma, LP., Fu, M.L.X. et al. Inflammation increases NT-proBNP and the NT-proBNP/BNP ratio. Clin Res Cardiol 99, 445–452 (2010). https://doi.org/10.1007/s00392-010-0140-z

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  • DOI: https://doi.org/10.1007/s00392-010-0140-z

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