Associations of NT-proBNP and hepcidin levels with clinical and laboratory parameters in patients with heart failure with various severity of left ventricular systolic dysfunction

Data on hepcidin levels in patients with heart failure (HF) are contradictory and do not make clear its contribution to the progression of multiple organ failure. There remain a number of issues about the prognostic significance of the N-terminal pro-brain natriuretic peptide (NT-proBNP) in HF with preserved ejection fraction (EF). The authors suggested the relationships between these markers in decompensated HF, as well as their associations with other clinical and laboratory parameters.

Aim. To identify the association of NT-proBNP and hepcidin levels with clinical and laboratory parameters in patients with HF with various severity of left ventricular (LV) systolic dysfunction.

Material and methods. The study included 68 patients (29 women, 39 men; mean age — 72,3±11,7 years) hospitalized due to decompensated HF. Patients were divided into three groups: reduced (HFrEF) (n=20), mid-range (HFmrEF) (n=23), and preserved EF (HFpEF) (n=24). Upon admission, along with standard diagnostic tests, all patients were examined for NT-proBNP and hepcidin levels by enzyme-linked immunosorbent assay. Statistical processing was carried out using the software package Statistica 8.0.

Results. NT-proBNP levels in the entire sample was 315,9 [129,9; 576,1] pg/ml. Significantly higher concentrations of NT-proBNP were found in patients with lower EF: 433,05 (346,8-892,6) pg/ml for HFrEF, 289,97 (185,9-345,3) pg/ml for HFmrEF pg/ml and 214,98 (207,37-562,31) pg/ ml for HFpEF (p<0,05). At the same time, hepcidin levels in the HFrEF group (31,63 ng/ml [22,0; 71,6]) was significantly higher than in the HFmrEF (23,89 ng/ml [21,1; 27,9]) (p<0,05) and HFpEF (26,91 ng/ml [18,6; 31,1]) (p<0,05). In HFpEF patients, there was a correlation of hepcidin level with body mass index (r=0,47, p<0,05) and chronic obstructive airway diseases (r=0,44, p<0,05). A correlation of hepcidin level with cardiac arrhythmias (r=0,61, p<0,05) was revealed in the HFmrEF group. In the HFrEF group, there were correlations of a significantly increased level of NT-proBNP (median — 433,05; 95% confidence interval: 346,8-892,6) with indicators of disease severity and multiple organ dysfunction: decrease in systolic blood pressure, cardiorenal syndrome, decrease in hemoglobin level and mean corpuscular hemoglobin concentration, characteristic of iron-deficiency anemia.

Conclusion. Patients with lower EF showed higher NT-proBNP values and a trend towards higher hepcidin levels. Relationships of hepcidin and NT-proBNP levels with following clinical parameters were found: body mass index, presence of obstructive airway diseases, cardiac arrhythmias, as well as low cardiac output syndrome, cardiorenal syndrome and anemia.

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