Brain natriuretic peptide is a marker of poor prognosis in decompensated liver cirrhosis

Abstract

Background: Patients with liver cirrhosis suffer from various cardiac abnormalities, which may influence their outcome. This condition, known as cirrhotic cardiomyopathy, is usually asymptomatic, subclinical. The aim of our study was to determine parameters associated with mortality in decompensated liver cirrhosis with particular focus on echocardiographic parameters and brain natriuretic peptide level (BNP).

Methods: For the purposes of our prospective non-intervention one-centre study we have included 61 patients with decompensated liver cirrhosis. Severity of disease was assessed according to Child-Turcotte-Pugh score and Model for End Stage Liver Disease (MELD). Cardiac functions were evaluated using echocardiography (inclusive non-invasive hemodynamic assessment and tissue Doppler measurement). BNP level at admission was recorded. In-hospital mortality and 1-year all-cause mortality were evaluated.

Results: We identified several negative prognostic markers of in-hospital and 1-year mortality: MELD score (p < 0.0001; p = 0.0007) and all it's components, Child-Pugh score (p = 0.004; p = 0.002), age (p = 0.03; p = 0.006) and InBNP (p = 0.001; p = 0.004). The echocardiographic parameters associated with in-hospital mortality were the left atrium diameter (p = 0.03) and higher cardiac index (p = 0.04). Both these parameters were, however, neutral in evaluation of 1-year mortality. Left ventricle diastolic dysfunction grade was found as another possible negative marker (p = 0.06 for in-hospital and p = 0.04 for 1-year mortality assessment). Prolongation of QTc was also associated with poor prognosis (p = 0.003; p = 0.002). BNP level was accompanied with hyperdynamic circulation (p = 0.05), systolic pulmonary artery pressure (p = 0.03), diastolic function of left ventricle (p = 0.01) and left atrial diameter (p = 0.02).

Conclusions: High level of BNP is associated with in-hospital and 1-year mortality of patients with decompensated liver cirrhosis. Addition of BNP to MELD or to other scoring systems could improve the prognostic accuracy. Definitive conclusion concerning BNP role in liver diseases requires further research.