Impact Of Renal Function Injury On The Diagnostic Value Of NT-proBNP In Patients With Heart Failure

Objective: To explore the impact of renal function injury on diagnostic value of NTproBNP in patients with heartfailure(HF);To evaluate the diagnostic value of NTproBNP in the diagnosis of heart failure.Methods: A total of 420 patients with cardiovascular disease at(50-75)years of age were divided into 2 groups basedon left ventricular ejection fraction(LVEF): Control group,the patients with normal cardiac function,LVEF?40%,n=232 and HF group,LVEF<40%,n =188.According to estimated glomerular filtration rate(e GFR),each group contained 4 subgroupsby Normal renal function(e GFR?90 ml/min·1.73 m 2),Mild renal injury(90>e GFR?60 ml/min·1.73 m 2),Moderate renal injury(60>e GFR?30ml/min·1.73 m 2)and Severe renal injury(e GFR<30 ml/min·1.73 m 2).The changes of NT-proBNP level atdifferent subgroups were observed and the optimal cut-off values of NT-proBNP for HF diagnosis were measured.Published papers concerning the impact of plasma NT-proBNP levels in patients with normal renal function and renal insufficiency in patients with heart failure,were searched fromdata base of Web of Science,Cochrance Library,Pub Med,Science Direct,Chinese Text(CNKI),Wan Fang DATA,Chongqing VIP,and Sino Med.The retrieval time was from the establishment of the base to April 2016.The research papers that meet the inclusion criteria were enrolled for Meta-analysis.Results: Compared with Control group,HF group had increased blood level of NTproBNP,P <0.05;NT-proBNP levelwas negatively related to e GFR(in all patients: r =-0.664,in Control group: r =-0.686 and in HF group: r =-0.721,P <0.05).Within Control group,NT-proBNP level was similar between Normal renal function and Mild renal injury subgroups,P >0.05,while it was much higher in Moderate and Severe renal injury subgroups than Normal renal function subgroup,P <0.05.Within HF group,Severe renal injury subgroup had increased NT-proBNP level than other subgroups,P <0.05.The best cut-off value of NT-proBNP for HF diagnosis in patients with normal or mild renal injury was 1070 pg/mL(sensitivity: 91.8%and specificity 72.6%);with moderate renal injury was 7121 pg/mL(sensitivity: 80.2% and specificity: 89.7%);with severerenal injury was33344 pg/mL(sensitivity: 83.3% and specificity: 80%).The level of NT-proBNP in patients of heart failure with renal insufficiency was significantly higher than that of normal renal function(SMD=?0.90,95%CI[?1.04,?0.75],P<0.01);According to the glomerular filtration rate(estimated,glomerular filtration rate,e GFR),the renal function was divided into four subgroups:normal renal function,mild renal injury,moderate renal injury and severe renal injury.Comparative analysis of sub group showed that with the decrease of e GFR,the plasma level of NT-proBNP is increased(SMD=?0.52,95%CI[?0.86,?0.19],P<0.01;SMD=?0.84,95%CI[?1.15,?0.52],P<0.01;SMD=?0.95,95%CI[?1.43,?0.47],P<0.01).Conclusion: Moderate to severe renal function injury could increase circulating level of NT-proBNP and therefore,thecut-off value of NT-proBNP for HF diagnosis should be elevated accordingly in patients of HF combing renal injury.