Correlation of NT-proBNP Levels with Outcome in Patients of Acute Decompensated Heart Failure

Abstract Background: Acute decompensated heart failure (ADHF) is a significant contributor to morbidity and mortality globally, particularly in resource-limited settings like India. NT-proBNP, a widely recognized biomarker for HF, provides diagnostic and prognostic insights, but its role in predicting mortality in Indian populations with ADHF remains underexplored. This study investigates the prognostic utility of NT-proBNP levels at admission and their relationship with inhospital mortality and left ventricular ejection fraction (EF) categories. Methods: A prospective observational study was conducted at UCMS and GTB Hospital, Delhi, over 18 months. Eighty-four patients aged ≥18 years, diagnosed with ADHF, were enrolled. NT-proBNP levels were measured at admission, and echocardiographic evaluation was used to categorize patients into HF with reduced ejection fraction (HFrEF) (<40%), HF with mid-range ejection fraction (HFmrEF) (40%–49%), and HF with preserved ejection fraction (HFpEF) (≥50%). Outcomes (discharge or mortality) were analyzed using Mann–Whitney U -tests, Chi-square tests, and logistic regression. Predictive performance was assessed using receiver operating characteristic (ROC) curves. Results: The mean NT-proBNP level was 2974.3 pg/mL (standard deviation: 1812.4). The median NT-proBNP level was significantly higher among those who died (5420; interquartile range [IQR]: 4525–7430) compared to those who survived (2130; IQR: 1600–3210) ( P < 0.001). Mortality was significantly higher in patients with NT-proBNP >2000 pg/mL (23.5%) compared to those with levels <2000 pg/mL (3%) ( P = 0.011). In HFrEF, mortality reached 61.5% for NT-proBNP >2000 pg/mL. Elevated NT-proBNP was associated with a 9.8-fold increased risk of mortality (OR: 9.8; 95% confidence interval: 1.2–79.8). Sepsis, elevated creatinine, and positive Troponin I were additional predictors of adverse outcomes. ROC analysis revealed a strong predictive value for NT-proBNP (area under the curve = 0.83). Conclusion: NT-proBNP is a robust predictor of inhospital mortality in ADHF, with its prognostic significance varying across EF categories. These findings highlight the utility of NT-proBNP in guiding risk stratification and individualized management, particularly in resource-limited settings. Incorporating NT-proBNP measurements into routine care can improve outcomes by identifying high-risk patients early.