International Journal of Medical Advances and Discoveries

International Journal of Medical Advances and Discoveries ISSN 2756-3812 Vol. 15 (2), pp. 001-006, February, 2024. Available online at www.internationalscholarsjournals.org © International Scholars Journals

Full Length Research Paper

Best Practices for NT-proBNP Reference Values: Findings from the CLEAN Assessment

Larry H. Bernstein¹*, Michael Y. Zions^1,4, Mohammed E. Alam^1,5, Salman A. Haq¹, John F. Heitner¹, Stuart Zarich², Bette Seamonds³ and Stanley Berger³

¹New York Methodist Hospital, Brooklyn, New York, USA.
²Bridgeport Hospital, Bridgeport, Connecticut, USA.
³Mercy Catholic Medical Center, Darby, Philadelphia, Pennsylvania, USA.
⁴Touro College, Brooklyn, New York, USA.
⁵Medgar Evers College, Brooklyn, New York, USA.

Accepted 8 September, 2023

Abstract

The natriuretic peptides, B-type natriuretic peptide (BNP) and NT-proBNP that have emerged as tools for diagnosing congestive heart failure (CHF) are affected by age and renal insufficiency (RI). NT-proBNP is used in rejecting CHF and as a marker of risk for patients with acute coronary syndromes. This observational study was undertaken to evaluate the reference value for interpreting NT-proBNP concentrations. The hypothesis is that increasing concentrations of NT-proBNP are associated with the effects of multiple co-morbidities, not merely CHF, resulting in altered volume status or myocardial filling pressures. NT-proBNP was measured in a population with normal trans-thoracic echocardiograms (TTE) and free of anemia or renal impairment. Study participants were seen in acute care for symptoms of shortness of breath suspicious for CHF requiring evaluation with cardiac NT-proBNP assay. The median NT-proBNP for patients under 50 years is 60.5 pg/ml with an upper limit of 462 pg/ml, and for patients over 50 years the median was 272.8 pg/ml with an upper limit of 998.2 pg/ml. We suggest that NT-proBNP levels can be more accurately interpreted only after removal of the major co-morbidities that affect an increase in this peptide in serum. The PRIDE study guidelines should be applied until presence or absence of comorbidities is diagnosed. With no comorbidities, the reference range for normal over 50 years of age remains steady at ~1000 pg/ml. The effect shown in previous papers likely is due to increasing concurrent comorbidity with age.

Key words: Congestive heart failure, natriuretic peptides, anemia, chronic renal insufficiency.