Prognostic value of extreme NT-proBNP levels in patients hospitalized for heart failure

Background and objective: To evaluate the prognostic value of extreme levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP) measured at any time during hospitalization for heart failure (HF). Materials and methods: A retrospective cohort study including patients hospitalized for HF in a secondary level hospital with at least one NT-proBNP measurement. Two groups were defined: patients extreme NT-proBNP levels (> 50,000 pg/mL) and those with elevated NT-proBNP levels (> 1800 pg/mL < 20,000 pg/mL). The primary outcome was a composite of(1) in-hospital mortality; (2) HF readmission, and (3) 6-month mortality. Cox survival models were used for analysis. Results: A total of 83 patients with extreme NT-proBNP levels and 100 with elevated NT-proBNP levels were included; 61% were women, with a median age of 87 years. Comorbidity burden was high and similar between groups (median Charlson index: 8). The primary outcome was more frequent in patients with extreme NT-proBNP levels: 25.02 vs. 10.53 events per 100 patient-months (HR 2.07; 95% CI: 1.37-3.14). Both in-hospital and 6-month mortality were significantly higher in the extreme NT-proBNP group, while HF readmissions were numerically higher but not statistically significant. These results remained consistent after multivariable adjustment. Conclusions: Patients hospitalized for HF with NT-proBNP levels > 50,000 pg/mL have a worse prognosis than those with NT-proBNP < 20,000 pg/mL, representing a high-risk subgroup with short-term mortality. (c) 2025 Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.