An NT-proBNP over 20,000 on admission more often meant infection than heart failure

The edition in brief

A retrospective study of 415 hospital admissions with NT-proBNP of 20,000 pg/mL or more (median age 82) found infection was the primary diagnosis in 60% and heart failure in only 19%. In-hospital mortality was 43.6% and 6-month mortality 64.5%; older age and lower albumin predicted death. A very high NT-proBNP on the ward should prompt a search for sepsis and a frank prognostic conversation, not an automatic heart-failure label. The American Gastroenterological Association's expert review on metabolic dysfunction- and alcohol-associated liver disease (MetALD) sets alcohol thresholds of about 140 to 350 g a week in women and 210 to 420 g in men, advises annual alcohol assessment, FIB-4-first fibrosis triage, and treatment of alcohol use disorder, and advises against bariatric surgery. A Toronto cluster trial found on-site multiplex PCR in 20 nursing homes did not reduce outbreak number or size but cut emergency transfers and brought antivirals 2.5 days earlier. An English cluster trial in 91 care homes found HEPA filters did not reduce residents' respiratory infections (rate ratio 0.92, 0.64 to 1.33).