NT-proBNP reflects heart failure (HF) severity and prognosis, although extracardiac conditions such as renal dysfunction and inflammation may also contribute to elevated levels. An observational study presented at the Heart Failure 2026 evaluated the clinical characteristics associated with extremely elevated NT-proBNP levels among hospitalized patients with HF.

The study included adult patients hospitalized with HF between July 2019 and February 2020, regardless of left ventricular ejection fraction (LVEF). Patients with repeat admissions or in-hospital mortality were excluded. Extremely elevated NT-proBNP (eeNT-proBNP) was defined as values within the upper 10th percentile of the cohort distribution.

Findings

• A total of 315 patients were included, with eeNT-proBNP values ranging from 7,145 to 70,000 pg/mL.
• Patients with eeNT-proBNP were older and had longer hospital stays, higher NYHA class, lower LVEF, and higher estimated systolic pulmonary artery pressure compared with the remainder of the cohort.
• History of myocardial infarction, stroke, atrial fibrillation, anemia, and hypothyroidism were more common among patients with eeNT-proBNP.
• Serum creatinine and C-reactive protein concentrations were significantly higher in the eeNT-proBNP group.
• Multivariable analysis identified higher NYHA class (HR: 6.30; 95% CI: 2.96-13.66; p < 0.001), lower LVEF (HR: 0.93; 95% CI: 0.90-0.96; p < 0.001), and higher serum creatinine (HR: 4.28; 95% CI: 2.08-8.82; p < 0.001) as independent correlates of eeNT-proBNP.
• The prediction model demonstrated strong discrimination for eeNT-proBNP (AUC: 0.88; 95% CI: 0.82-0.95; p < 0.001).

The findings suggest that extremely elevated NT-proBNP levels in hospitalized patients with HF are associated with higher NYHA class, lower LVEF, and impaired renal function.