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BNP and NT-proBNP as prognostic markers in persons with acute decompensated heart failure: a systematic review

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Abstract

A systematic review was undertaken to examine the evidence for B-type natriuretic peptides (BNP and NT-proBNP) as independent predictors of mortality, morbidity, or combined mortality and morbidity outcomes in persons with acute decompensated heart failure (ADHF). Electronic databases (Medline®, Embase™, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL) were searched from 1989 to June 2012. Reference lists of included articles, systematic reviews, and the gray literature were also searched. English language studies were eligible if they included subjects with ADHF and measured BNP/NT-proBNP using FDA approved assays. Standardized forms were used to select studies, extract data, and assess risk of bias. Seventy-nine studies, ranging over followup intervals from 14 days to 7 years, evaluating levels of BNP (n = 38), NT-proBNP (n = 35), or both (n = 6) were eligible. The majority of studies predicted mortality outcomes for admission BNP/NT-proBNP levels, with fewer studies evaluating serial, change from admission, or discharge levels. In general, higher levels of admission BNP or NT-proBNP predicted greater risk for all outcomes. Decreased levels post-admission predicted decreased risk. Overall, these studies were rated as having moderate risk of bias. This systematic review shows that BNP and NT-proBNP are independent predictors of mortality (all-cause and cardiovascular) in ADHF despite different cutpoints, time intervals, and prognostic models. Findings for morbidity and composite outcomes were less frequently evaluated and showed inconsistency. Further research is required to assess cutpoints for admission, serial measurements, change following admission, and discharge levels to assist clinical decision-making.

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Acknowledgments

This manuscript is based on research conducted by the McMaster Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007-10060-I). The findings and conclusions in this paper are those of the authors, who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality. No statement herein should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services. Parminder Raina holds a Tier 1 Canada Research Chair in Geroscience and the Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging.

Conflict of interest

Mark Oremus, Robert McKelvie, Pasqualina L. Santaguida, Usman Ali, Cynthia Balion, Stephen Hill, Judy A. Brown, Amy Bustamam, Nazmul Sohel, and Parminder Raina have no conflicts of interest or financial ties to disclose. Andrew C. Don-Wauchope has received clinical trial support from AMGEN. Ronald A. Booth has received honoraria from INOVA Diagnostics Inc. and is a member of the Health Technology Expert Review Panel of the Canadian Agency for Drugs and Technologies in Health (CADTH).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Canada

    Pasqualina L. Santaguida, Mark Oremus, Usman Ali, Judy A. Brown, Amy Bustamam, Nazmul Sohel & Parminder Raina

  2. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada

    Andrew C. Don-Wauchope, Stephen A. Hill & Cynthia Balion

  3. Department of Medicine, McMaster University, Hamilton, Canada

    Robert McKelvie

  4. Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada

    Ronald A. Booth

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  1. Pasqualina L. Santaguida
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Santaguida, P.L., Don-Wauchope, A.C., Oremus, M. et al. BNP and NT-proBNP as prognostic markers in persons with acute decompensated heart failure: a systematic review. Heart Fail Rev 19, 453–470 (2014). https://doi.org/10.1007/s10741-014-9442-y

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