The blood level of B-type natriuretic peptide drawn at admission from patients with heart failure correlates directly with likelihood of in-hospital mortality, according to an article in the May 15 issue of the Journal of the American College of Cardiology.

“We hope the findings will help physicians more effectively stratify risk and guide treatment. This is the first study to definitively demonstrate a connection between B-type natriuretic peptide (BNP) and in-hospital mortality risk among heart failure patients,” said principal investigator Gregg C. Fonarow, MD, UCLA’s Eliot Corday Chair in Cardiovascular Medicine and Science, professor of cardiology and director of the Ahmanson?UCLA Cardiomyopathy Center. “This is also the largest biomarker study in heart failure ever conducted.”

The researchers analyzed data for 48,629 out of 77,467 heart failure patients whose blood levels were taken within 24 hours of hospital admission. The patient data, collected between April 2003 and December 2004 at 191 hospitals across the USA, were part of the Acute Decompensated Heart Failure National Registry (ADHERE), a US registry of heart failure patients.

Investigators assessed in-hospital mortality after classifying patients into one of four groups based on blood peptide level: A level of less than 430 pg/mL (picograms per milliliter) corresponded with a mortality rate of 1.9 percent; a level between 430 and 839 pg/ml corresponded with a mortality rate of 2.8 percent; a level between 840 to 1,729 pg/mL corresponded with a mortality rate of 3.8 percent; and a level of 1,730 pg/mL or more corresponded with a mortality rate of 6 percent.

“We were very surprised that this blood test was so highly predictive of mortality across a broad population of heart failure patients and range of BNP levels,” said Fonarow.

Researchers found B-type natriuretic peptide levels remained predictive of mortality even after adjustment for age, gender, systolic blood pressure, pulse and other lab tests, such as blood urea nitrogen, creatinine and sodium. It also held regardless of left ventricular function.

Higher levels were also predictive of other clinical outcomes such as need for mechanical ventilation, length of the hospital stay, and the amount of time in the intensive care unit.

Fonarow said that testing for peptide levels may be a useful addition to routine assessment and can help guide care and treatment of patients hospitalized with acute heart failure. He noted that a test provides quick results, often within 15 minutes to a few hours, which can provide physicians with additional information to help in medical decision-making.

The next step will be further research to demonstrate that patients with higher peptide levels at admission benefit from more intensive monitoring and treatment.