- Design
- Retrospective single-centre cohort
- Population
- 415 adult admissions with NT-proBNP ≥20,000 pg/mL; median age 82
- Primary outcome
- Primary diagnosis and all-cause mortality
- Effect
- Infection 60%, heart failure 19%; 6-month mortality 64.5%
This retrospective study reviewed adult hospital admissions with NT-proBNP of 20,000 pg/mL or more: 415 admissions, median age 82, median NT-proBNP 35,000 pg/mL. It was published in the Journal of General Internal Medicine on 22 September.
Infection was the primary diagnosis in 60% and heart failure in 19%. Imaging showed pulmonary congestion in 55% and infection in 54%, often together. In-hospital mortality was 43.6% and 6-month mortality 64.5%, highest among those with infection. Older age and lower albumin independently predicted death.
On the medical take, a very high NT-proBNP is easily read as decompensated heart failure and treated with diuretics while sepsis is missed. These data argue the opposite default in older inpatients: look for infection, treat it, and recognise that the number itself signals a high risk of death that should shape conversations about goals of care.
- Look actively for sepsis in any admission with NT-proBNP ≥20,000 pg/mL.
- Take cultures and consider antibiotics before attributing breathlessness to heart failure alone.
- Check albumin and renal function; both shape prognosis and interpretation.
- Use the result to prompt an early goals-of-care discussion in frail older patients.
Why it matters
It challenges the reflex that a very high natriuretic peptide means heart failure.
Don't overread it
A descriptive single-centre series; it does not show that changing management improves outcomes.
The statistics, in plain English
This is a single-centre retrospective series with no comparison group, so it describes who these patients were rather than testing a strategy. Primary diagnoses were taken from records, which can be imprecise when infection and heart failure coexist. Renal impairment, which raises NT-proBNP, was likely common.
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