- Design
- Retrospective 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% vs heart failure 19% of diagnoses; 6-month mortality 64.5%
A retrospective cohort studied 415 unselected hospital admissions with NT-proBNP of 20 000 pg/mL or more. Median age was 82 and median NT-proBNP 35 000 pg/mL.
Infection was the primary diagnosis in 60% and the cause of 71% of deaths; heart failure was the primary diagnosis in only 19%. Pulmonary congestion was seen on imaging in 55%, but so were signs of infection in 54%. Mortality was 43.6% in hospital and 64.5% at six months, and was highest in patients with infection. Older age and lower albumin independently predicted death.
An extreme natriuretic peptide is easily read as decompensated heart failure, prompting diuresis while sepsis goes unaddressed. In these patients it was more often a marker of how sick they were than of which organ had failed. This is a retrospective series of very old patients, and it does not mean heart failure was absent — but it supports looking for infection before settling on the diagnosis, and treating the value as a prognostic warning.
- With NT-proBNP above 20 000 pg/mL, check for infection — cultures, lactate, chest imaging — before attributing it to heart failure alone.
- Use an extreme value as a prompt for an early conversation about prognosis and goals of care.
- Low albumin and advanced age added to the risk of death in this cohort.
- Echocardiography still has a place where heart failure remains a real possibility.
Why it matters
It challenges the reflex that a very high NT-proBNP means heart failure and a diuretic.
Don't overread it
This retrospective series of very old patients shows association, not that infection raises NT-proBNP more than heart failure does.
The statistics, in plain English
Percentages here describe one cohort's admissions; they show what extreme values tend to accompany, not the probability for any single patient. The high mortality reflects an elderly, acutely ill population.
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