NT-PROBNP AS A PREDICTOR OF MORTALITY IN ACUTE HEART FAILURE: A RETROSPECTIVE COHORT STUDY

Abstract

Background: Acute heart failure is associated with substantial in-hospital morbidity and mortality. N-terminal pro B-type natriuretic peptide (NT-proBNP) is widely used in the diagnosis of heart failure and may also provide important prognostic information regarding short-term clinical outcomes. Objective: To evaluate the predictive value of admission NT-proBNP for in-hospital mortality in patients with acute heart failure. Methods: This retrospective cohort study was conducted at Army Cardiac Hospital, Lahore, Pakistan from October 2025 to May 2026, included 200 adult patients admitted with acute heart failure. Demographic, clinical, laboratory, and echocardiographic data were obtained from medical records. Results: Of 200 patients, 24 (12.0%) died during hospitalization. Non-survivors had significantly higher median NT proBNP levels than survivors, 11,850 (IQR 7,120–18,900) versus 4,380 (2,210–7,460) pg/mL (p<0.001). Mortality increased progressively from 2.0% in patients with NT-proBNP <2,000 pg/mL to 28.0% in those with levels ≥9,000 pg/mL (p<0.001). An NT-proBNP cutoff of 6,500 pg/mL showed an AUC of 0.79 (95% CI: 0.70–0.88), sensitivity of 79.2%, specificity of 73.3%, and negative predictive value of 96.3%. NT-proBNP >6,500 pg/mL remained an independent predictor of mortality (aOR 4.82; 95% CI: 1.67–13.92; p=0.004), along with chronic kidney disease and systolic blood pressure <110 mmHg. Conclusion: It is concluded that admission NT-proBNP is a useful predictor of in-hospital mortality in patients with acute heart failure. Higher NT-proBNP levels were associated with progressively greater mortality and adverse clinical outcomes, supporting its use as part of early risk stratification.