Evaluation of N-terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) as a Prognostic Marker in Patients With Acute Heart Failure in the Emergency Department.

BACKGROUND

Acute heart failure is a common cause of emergency department admissions and is associated with high morbidity and mortality.

OBJECTIVE

To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in predicting severity and clinical outcomes in patients presenting with acute heart failure in the emergency department.

METHODS

This cross-sectional analytical study was conducted at the Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan from January 2025 to July 2025, on 225 patients diagnosed with acute heart failure. NT-proBNP levels were measured at admission. Patients were followed during hospital stay for outcomes including severity of heart failure, need for ICU admission, duration of hospital stay, complications, and in-hospital mortality.

RESULTS

The mean NT-proBNP level was significantly higher in patients with severe heart failure compared to mild to moderate cases (6,920 ± 2,310 pg/mL vs 3,240 ± 1,580 pg/mL, p < 0.001). Patients requiring ICU admission and those with complications or mortality had markedly elevated NT-proBNP levels (p < 0.001). A significant positive correlation was observed between NT-proBNP levels and duration of hospital stay (r = 0.52, p < 0.001). Receiver operating characteristic curve analysis showed good predictive accuracy for severe acute heart failure, with an area under the curve of 0.86 (95% CI: 0.80-0.91; p<0.001). The optimal NT-proBNP cutoff value of 5000 pg/mL was determined using the Youden Index, yielding a sensitivity of 82.1% and specificity of 76.4%.

CONCLUSION

NT-proBNP is a reliable prognostic marker in acute heart failure, strongly associated with disease severity, adverse outcomes, and prolonged hospitalization. Its use in the emergency department can facilitate early risk stratification and guide clinical decision-making.