Internal and Emergency Medicine

, Volume 12, Issue 5, pp 593–603 | Cite as

Different trajectories and significance of B-type natriuretic peptide, congestion and acute kidney injury in patients with heart failure

  • Matteo Beltrami
  • Gaetano Ruocco
  • Aladino Ibrahim
  • Barbara Lucani
  • Beatrice Franci
  • Ranuccio Nuti
  • Alberto PalazzuoliEmail author


The exact relationship existing among congestion status, brain natriuretic peptide (BNP) changes and acute kidney injury (AKI) has not been elucidated in patients with acute heart failure (AHF). The aims of this study are: to investigate the relation and prognostic role of BNP, AKI and clinical congestion after discharge; to define the exact BNP cut off value or a BNP in-hospital reduction to identify patients with higher risk during vulnerable post-discharge phase. We consecutively enrolled 157 patients with a diagnosis of AHF. BNP and creatinine were measured in all patients, and degree of failure was assessed. AKI was defined as a creatinine increase ≥0.3 mg/dL or eGFR reduction ≥20% during hospitalization. All patients were followed for 1 and 3 months. Of 146 included patients, 110 patients (75%) displayed effective decongestion, 116 (79%) showed a BNP decrease ≥30%, and 28 (19%) developed in-hospital AKI. BNP in-hospital decrease ≥30% was found more often in patients who showed good decongestion in comparison to patients in persistent failure (63 vs 22%; p < 0.001). The ROC curve analyses at 3 months show that both BNP reduction of 30% between admission and discharge and decongestion at discharge identifies patients with a reduced incidence of cardiovascular events (AUC = 0.79, confidence interval 0.68–0.90, sensibility 90%, sensitivity 50% p < 0.001). Kaplan–Meier survival plots show a better outcome in patients with a BNP decrease ≥30% and good decongestion at discharge (p = 0.03). BNP reduction in AHF is associated with decongestion. BNP reduction associated with decongestion at discharge is a favorable prognostic indicator at 90-day survival irrespective of the AKI occurrence.


B-type natriuretic peptide Clinical congestion Heart failure Acute kidney injury Outcome 



MB made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of the data; GR made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of the data; AI revised the english language; BL analyzed blood samples; BF analyzed blood samples; AP made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of the data, drafted the article or revised it critically for important intellectual content and approved the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This study was approved by the Local Investigational Human Review Board.

Informed consent

All patients gave their signed informed consent.


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Copyright information

© SIMI 2017

Authors and Affiliations

  • Matteo Beltrami
    • 1
  • Gaetano Ruocco
    • 1
  • Aladino Ibrahim
    • 1
  • Barbara Lucani
    • 1
  • Beatrice Franci
    • 1
  • Ranuccio Nuti
    • 1
  • Alberto Palazzuoli
    • 1
    • 2
    Email author
  1. 1.Cardiovascular Diseases Unit, Department of Internal Medicine, S. Maria alle Scotte HospitalUniversity of SienaSienaItaly
  2. 2.Department of Internal Medicine and Metabolic Diseases, CardiologyLe Scotte HospitalSienaItaly

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