N-terminal pro-brain natriuretic peptide: prognostic potential in end stage liver cirrhosis in a cohort free of heart failure; an Egyptian insight

Background and Aim: Natriuretic peptide [NP] system has emerged as one of the most important hormonal systems in control of cardiovascular homeostasis. Liver cirrhosis may affect NP levels that ere well described in heart failure. NP prognostic evaluation was well established in many diseases. Our aims were to measure serum and ascitic NT-proBNP levels in cirrhotic and cardiac Egyptian patients to diagnose a cut-off value for exclusion of heart failure, to assess if cirrhosis per se may contribute in NT-proBNP elevation and to assess the contribution of these levels as predictors of mortality in liver cirrhosis

Patients and Methods: A prospective cohort study was conducted in 80 patients [50 cirrhotics and 30 had heart failure]. Serum and ascitic [if available] NT-proBNP were measured. Cirrhotic patients were followed for 1-year. Kaplan-Meier survival analysis was used to evaluate 1-year survival rates. Logistic regression analyses were performed with 1-year mortality as the dependent variable

Results: Median serum and ascitic NT-proBNP levels in cirrhotics were 239.4 and 267 pg/ml versus 10596.6 and 9771 pg/ml in heart failure patients [P<0.001]. Serum and ascitic NT-proBNP cut-off values >1000 pg/ml resulted in sensitivity of 100% and 93.3% and specificity of 97.8% and 92.5% for exclusion of cardiac disease in cirrhotics. NT-proBNP was elevated in cirrhotics compared with age matched controls [P<0.001] and significantly correlated with severity of liver cirrhosis based on Child-Pugh and MELD [P=0.05, P<0.001 respectively]. Higher NT-proBNP associated with increased 1-year mortality. NT-proBNP was an independent predictor for mortality in cirrhotics in addition to other conventional factors

Conclusion: NT-pro BNP could be a powerful initial non-invasive diagnostic tool for exclusion of heart disease in cirrhotic patients. End stage cirrhosis per se may contribute to NT-proBNP elevation. NT-proBNP provided incremental information in 1-year mortality prediction in decompensated cirrhotics

Prognostic significance of high sensitivity C-reactive protein before and after percutaneous coronary intervention in patients with angina pectoris

C-reactive protein is an easily measurable acute phase reactant synthesized by hepatocytes in respone to pro-inflammatory cytokines. Elevated CRP has been identified as a strong predictor of prognosis in healthy individuals, in patients with stable angina, in unstable angina and in patients after acute myocardial infarction. The prognostic significance of high sensitivity CRP level in percutaneous coronary intervention is unclear. We prospectively studied 41 patients with chronic stable angina [28 patients] and unstable angina [13 patients] who underwent elective coronary stenting. All patients had normal troponin level before the procedure. Blood samples for hs-CRP were obtained before the procedure, 24 hours and 1 month after the procedure. Mean hs-CRP before the procedure in all patients who underwent PCI was 2.38 +/- 2.21 microg/ml. the mean hs-CRP 24 hours post procedure was 7.43=10.6 microg/ml. The mean hs-CRP after 1 month was 11.8=13.5 microg/ml. there was significant difference between pre procedural hs-CRP and 24 hours post procedural [P=0.007]and there was significant difference between pre procedural hs-CRP and 1 month post procedural [P=0.000]. At follow up period [1 month]. No major adverse cardiac events [MACE] have occurred. However, 24 patients complained of chest pain. There was no significant correlation between either pre-procedural, or 24 hours post procedure hs-CRP and chest pain [r=0.13, 0.2 respectively] Mechanical disruption of atherosclerotic plaque during coronary stent implantation causesasystemic inflammatory respone. We did not find that measuring hs-CRP level pre or post procedural is useful for predicting 30 days cardiac events