BACKGROUND: B-type natriuretic peptide (BNP) concentrations are high in 
cirrhosis, possibly related to volume status and cirrhotic cardiomyopathy. The 
prognostic significance of BNP in cirrhosis is unknown.
AIMS: We aimed to evaluate (i) the influence of haemodynamic parameters and 
volaemia, assessed by impedance cardiography (ICG), in BNP levels, (ii) the 
performance of BNP as a prognostic marker, in a cohort of cirrhotic patients.
METHODS: Patients consecutively hospitalized with decompensated cirrhosis during 
1 year were evaluated. At admission, ICG and BNP measurements were performed in 
83 patients (median age 56 years; median Child-Pugh score=10). The 70 patients 
discharged were followed for the occurrence of death within 6 months.
RESULTS: Median BNP levels were 130.3 (65.2-363.3) pg/ml. Independent BNP 
predictors in multivariate linear regression analysis were cardiac output, age 
and haemoglobin (R(2)=36.7%). The 24 patients with cardiac systolic dysfunction, 
defined by low cardiac output, had higher BNP concentrations than the other 
patients (230.8 vs 98.5 pg/ml, P=0.003). BNP levels above median were associated 
with an increased occurrence of death within 6 months of discharge (log rank 
P=0.023). Cardiac output and BNP were predictors of survival in univariate Cox 
regression analysis. Only BNP remained independently related to the outcome in 
multivariate analysis [hazard ratio=2.86 (1.11-7.38), P=0.03].
CONCLUSIONS: BNP levels in cirrhosis reflect cardiac systolic function and 
non-cardiac variables that should be considered in their interpretation. BNP is 
an independent predictor of medium-term survival in advanced cirrhosis, 
suggesting its utility in risk stratification of decompensated cirrhotic 
patients.