The Association of N-terminal Pro-B-Type Natriuretic Peptide with Haemoglobin and Ferritin in Heart Failure Patients

Introduction: The adverse prognosis of heart failure (HF) correlates with both N-terminal pro-B-type natriuretic peptide (NT-proBNP) and ferritin. The contribution of an underlying inflammatory process in the pathogenesis of HF is not only evidenced by increased ferritin (acute phase reactant), but also a reduced haemoglobin (Hb) due to cytokine-mediated bone marrow suppression. However, it remains unknown if there is a linear relationship between NT-pro BNP with ferritin and Hb levels. Objective: To determine an association between very elevated levels of NT-proBNP (>10,000pg/ ml) with Hb and ferritin in patients with HF. Methods: A retrospective, cross-sectional study to evaluate levels of ferritin and Hb among patients with very high NT-proBNP levels (>10,000pg/ml) treated at a district hospital serving a population of 500,000 people. Inclusion criteria: in-patient between October to December 2020, diagnosis of HF, NT-proBNP level >10,000 pg/ml, measured haemoglobin and ferritin level within 7 days of NT-proBNP measurement. Results: Forty-five patients met all of the inclusion criteria. Mean age 81 years ± 12 years. There was a positive correlation between NT- proBNP with ferritin and a negative correlation between NT-proBNP and Hb. With NT-proBNP on the x-axis and Hb on the y-axis, the trend line equated y = -0.0003x + 124.88. With NT-proBNP on the x-axis and ferritin on the y-axis, the trend line equated y = 0.0043x + 311.6. Conclusion: With rising levels of NT-proBNP, Hb levels decrease and ferritin levels increase in a linear manner, simultaneously. Larger studies are required to confirm this observation and to investigate the clinical implications of these findings.