Prognostic role of NT-proBNP and ultrasound assessment of venous congestion according to the VEXUS protocol in patients with acute decompensation of heart failure in the intensive care unit

Aim. To determine the prognostic value of NT-proBNP and ultrasound assessment of venous congestion according to the VEXUS protocol in patients hospitalized with acute decompensation of heart failure (ADHF) in the intensive care unit (ICU) in relation to adverse outcomes for HF during a year of follow-up.

Materials and methods. A prospective observational study included 150 patients hospitalized with ADHF in the ICU. All patients included in the study at admission and discharge underwent standard physical, laboratory and instrumental examinations, including NT-proBNP, lung ultrasound, assessment of venous congestion according to the VExUS protocol. The assessment of long-term clinical events was carried out by a structured telephone survey 1, 3, 6, 12 months after discharge. The total rate of total mortality and repeated hospitalizations for HF was estimated as the endpoint.

Results. During 1 year of follow–up, 58 events (38 %) were detected, 50 deaths (33 %), 8 repeated hospitalizations (5 %). Patients with events were significantly older, characterized by more pronounced laboratory and instrumental assessment of congestion, diameter of the inferior vena cava, and venous congestion. The following threshold values were identified by ROC curves for predicting outcomes (total mortality + re–hospitalization) − the degree of venous congestion according to the VExUS GRADE protocol >2 and the level of NT-proBNP>10806 pg/ml at admission, the diameter of the inferior vena cava >2.3 cm at discharge.

Conclusion: NT-proBNP>10806 pg/ml and GRADE>2 of venous congestion according to the VExUS protocol in patients admitted to the ICU with ADHF, have prognostic value in relation to the risk of adverse outcomes (total mortality and repeated hospitalizations) during a year of follow-up.

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