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HelpTest ID: PBNP1 NT-Pro B-Type Natriuretic Peptide, Serum
Necessary Information
Patient's age and sex are required.
Specimen Required
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions:
1. Serum gel tubes should be centrifuged within 2 hours of collection.
2. Red-top tubes should be centrifuged, and the serum aliquoted into a plastic vial within 2 hours of collection.
Useful For
Aiding in the diagnosis of congestive heart failure using serum specimens
Testing Algorithm
For more information see Amyloidosis: Laboratory Approach to Diagnosis
Special Instructions
Method Name
Electrochemiluminescence Immunoassay
Reporting Name
NT-Pro BNP, SSpecimen Type
SerumSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Frozen (preferred) | 365 days | |
| Refrigerated | 7 days |
Clinical Information
B-type natriuretic peptide (formerly brain natriuretic peptide: BNP) is a small, ringed peptide secreted by the heart to regulate blood pressure and fluid balance.(1) This peptide is stored in, and secreted predominantly from, membrane granules in the heart ventricles in a pro form (proBNP). Once released from the heart in response to ventricle volume expansion or pressure overload, the N-terminal (NT) piece of 76 amino acids (NT-proBNP) is rapidly cleaved by the enzymes corin and furin to release the active 32-amino acid peptide (BNP).(2)
Both BNP and NT-proBNP are markers of atrial and ventricular distension due to increased intracardiac pressure. The New York Heart Association (NYHA) developed a 4-stage functional classification system for congestive heart failure (CHF) based on the severity of the symptoms. Studies have demonstrated that the measured concentrations of circulating BNP and NT-proBNP increase with the severity of CHF based on the NYHA classification.
Reference Values
Males
0-2 day: 321-11,987 pg/mL
3-11 day: 263-5918 pg/mL
12 day-1 month: Not applicable
2 month-1 year: 37-646 pg/mL
2 years: 39-413 pg/mL
3 years-6 years: 23-289 pg/mL
7 years-14 years: ≤157 pg/mL
15 years-18 years: ≤158 pg/mL
19-39 years: <79 pg/mL
40-44 years: ≤72 pg/mL
45-54 years: ≤87 pg/mL
55-64 years: ≤88 pg/mL
≥65 years: ≤540 pg/mL
Females
0-2 day: 321-11,987 pg/mL
3-11 day: 263-5918 pg/mL
12 day-1 month: Not applicable
2 month-1 year: 37-646 pg/mL
2 years: 39-413 pg/mL
3 years-6 years: 23-289 pg/mL
7 years-14 years: < or=157 pg/mL
15 years-18 years: ≤158 pg/mL
19-39 years: <160 pg/mL
40-44 years: ≤162 pg/mL
45-54 years: ≤141 pg/mL
55-64 years: ≤226 pg/mL
≥65 years: ≤540 pg/mL
Interpretation
Under 50 years of age:
N-terminal pro B-type natriuretic peptide (NT-proBNP) values below 300 pg/mL have a 99% negative predictive value for excluding acute congestive heart failure (CHF). A cutoff of 1200 pg/mL for patients with an estimated glomerular filtration rate (eGFR) below 60 yields a diagnostic sensitivity and specificity of 89% and 72% for acute CHF. NT-proBNP values greater than 450 pg/mL are consistent with CHF in adults under 50 years of age.
50-75 years of age:
NT-proBNP values below 300 pg/mL have a 99% negative predictive value for excluding acute CHF. A cutoff of 1200 pg/mL for patients with an eGFR below 60 yields a diagnostic sensitivity and specificity of 89% and 72% for acute CHF. A diagnostic NT-proBNP cutoff of 900 pg/mL has been suggested for adults 50 to 75 years of age in the absence of kidney failure.
Over 75 years of age:
NT-proBNP values below 300 pg/mL have a 99% negative predictive value for excluding acute CHF. A cutoff of 1200 pg/mL for patients with an eGFR below 60 yields a diagnostic sensitivity and specificity of 89% and 72% for acute CHF. A diagnostic NT-proBNP cutoff of 1800 pg/mL has been suggested for adults over 75 years of age in the absence of kidney failure.
NT-Pro BNP levels are loosely correlated with New York Heart Association (NYHA) functional class (see Table).
Table. Interpretive Levels for CHF
|
Functional class |
5th to 95th percentile |
Median |
|
I |
31-1110 pg/mL |
377 pg/mL |
|
II |
55-4975 pg/mL |
1223 pg/mL |
|
III |
77-26,916 pg/mL |
3130 pg/mL |
|
IV |
* |
* |
|
*In a Mayo Clinic study of 75 patients with CHF, only 4 were characterized as class IV. Accordingly, range and median are not provided. |
||
Clinical Reference
1. Januzzi JL, van Kimmenade RR, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the international collaborative of NT-proBNP study. Eur Heart J. 2006;27(3):330-337. doi:10.1093/eurheartj/ehi631
2. van Kimmenade RR, Pinto YM, Bayes-Genis A, et al. Usefulness of intermediate amino-terminal pro-brain natriuretic peptide concentrations for diagnosis and prognosis of acute heart failure. Am J Cardiol. 2006;98(3):386-390. doi:10.1016/j.amjcard.2006.02.043
3. DeFilippi C, van Kimmenade R, Pinto YM. Amino-terminal pro-B-type natriuretic peptide testing in renal disease. Am J Cardiol. 2008;101(3A):82- 88. doi:10.1016/j.amjcard.2007.11.029
4. Rifai N, Horwath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018
Day(s) Performed
Monday through Sunday
Report Available
Same day/1 to 2 daysTest Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.CPT Code Information
83880
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PBNP1 | NT-Pro BNP, S | 83107-3 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| PBNP1 | NT-Pro BNP, S | 83107-3 |
Forms
If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.
mml-heart-failure