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25647 NT-Pro-B Type Natriuretic Peptide (PBNP)

NT-Pro-B Type Natriuretic Peptide (PBNP)
Test Code: PBNPSO
Synonyms/Keywords
​N Termial proNP, NT Pro BNP, ProBNP (B-Type Natriuretic Peptide)
Useful For
​An aid in the diagnsis of congestive heart failure.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​0.5 mL ​0.3 mL
Collection Processing Instructions

Patient Preparation: For 12 hours before specimen collection do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.​ Patient's age and sex are required.

Serum gel tubes should be centrifuged within 2 hours of collection.  Red Top Tubes should be centrifuged and aliquoted within 2 hours of collection. 

Specimen Stability Information
Specimen Type Temperature Time
​Serum ​ ​Frozen (preferred) ​365 days
​Refrigerate ​7 days
Rejection Criteria
Gross Hemolysis
Interference
Lack of N-terminal-pro brain natruretic peptide (NT-proBNP) elevations have been reported if congestive heart failure is very acute (first hour) or occurs with ventricular inflow obstruction (hypertrophic obstructive cardiomyopathy, mitral stenosis, atrial myxoma).
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Sunday ​1-2 days ​Electrochemiluminescence Immunoassay (ECLIA)
Reference Lab
Test Information

​B-type natriuretic peptide (brain natriuretic peptide: BNP) is a small, ringed peptide secreted by the heart to regulate blood pressure and fluid balance. 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).

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 Range Information
​Males​Females

< or =45 years: < or =51 pg/mL

46 years: < or =53 pg/mL

47 years: < or =55 pg/mL

48 years: < or =56 pg/mL

49 years: < or =58 pg/mL

50 years: < or =59 pg/mL

51 years: < or =61 pg/mL

52 years: < or =62 pg/mL

53 years: < or =64 pg/mL

54 years: < or =67 pg/mL

55 years: < or =68 pg/mL

56 years: < or =70 pg/mL

57 years: < or =71 pg/mL

58 years: < or =73 pg/mL

59 years: < or =76 pg/mL

60 years: < or =77 pg/mL

61 years: < or =79 pg/mL

62 years: < or =82 pg/mL

63 years: < or =83 pg/mL

64 years: < or =85 pg/mL

65 years: < or =88 pg/mL

66 years: < or =89 pg/mL

67 years: < or =92 pg/mL

68 years: < or =95 pg/mL

69 years: < or =97 pg/mL

70 years: < or =100 pg/mL

71 years: < or =103 pg/mL

72 years: < or =104 pg/mL

73 years: < or =107 pg/mL

74 years: < or =110 pg/mL

75 years: < or =113 pg/mL

76 years: < or =116 pg/mL

77 years: < or =119 pg/mL

78 years: < or =122 pg/mL

79 years: < or =125 pg/mL

80 years: < or =128 pg/mL

81 years: < or =131 pg/mL

82 years: < or =135 pg/mL

> or =83 years: < or =138 pg/mL

< or =46 years: < or =140 pg/mL

47 years: < or =141 pg/mL

48 years: < or =144 pg/mL

49 years: < or =146 pg/mL

50 years: < or =149 pg/mL

51 years: < or =150 pg/mL

52 years: < or =152 pg/mL

53 years: < or =155 pg/mL

54 years: < or =157 pg/mL

55 years: < or =160 pg/mL

56 years: < or =162 pg/mL

57 years: < or =166 pg/mL

58 years: < or =168 pg/mL

59 years: < or =171 pg/mL

60 years: < or =173 pg/mL

61 years: < or =177 pg/mL

62 years: < or =179 pg/mL

63 years: < or =183 pg/mL

64 years: < or =185 pg/mL

65 years: < or =189 pg/mL

66 years: < or =193 pg/mL

67 years: < or =196 pg/mL

68 years: < or =199 pg/mL

69 years: < or =202 pg/mL

70 years: < or =206 pg/mL

71 years: < or =210 pg/mL

72 years: < or =214 pg/mL

73 years: < or =218 pg/mL

74 years: < or =222 pg/mL

75 years: < or =227 pg/mL

76 years: < or =230 pg/mL

77 years: < or =235 pg/mL

78 years: < or =239 pg/mL

79 years: < or =244 pg/mL

80 years: < or =248 pg/mL

81 years: < or =253 pg/mL

82 years: < or =258 pg/mL

> or =83 years: < or =263 pg/mL

 

Interpretation

Under 50 years of age:

N-terminal pro brain 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 1,200 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 to 75 years of age:

NT-proBNP values below 300 pg/mL have a 99% negative predictive value for excluding acute CHF. A cutoff of 1,200 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 in adults 50 to 75 years of age in the absence of renal 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 1,200 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 1,800 pg/mL has been suggested in adults over 75 years of age in the absence of renal failure.

NT-Pro BNP levels are loosely correlated with New York Heart Association (NYHA) functional class

 
Interpretive Levels for CHF
Functional Class
5th to 95th Percentile
Median
I
31-1,110 pg/mL
377 pg/mL
II
55-4,975 pg/mL
1,223 pg/mL
III
77-26,916 pg/mL
3,130 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.
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​83880
Synonyms/Keywords
​N Termial proNP, NT Pro BNP, ProBNP (B-Type Natriuretic Peptide)
Ordering Applications
Ordering Application Description
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Serum ​Serum Separator Tube (SST) ​Red Top Tube (RTT) ​0.5 mL ​0.3 mL
Collection Processing

Patient Preparation: For 12 hours before specimen collection do not take multivitamins or dietary supplements containing biotin (vitamin B7), which is commonly found in hair, skin, and nail supplements and multivitamins.​ Patient's age and sex are required.

Serum gel tubes should be centrifuged within 2 hours of collection.  Red Top Tubes should be centrifuged and aliquoted within 2 hours of collection. 

Specimen Stability Information
Specimen Type Temperature Time
​Serum ​ ​Frozen (preferred) ​365 days
​Refrigerate ​7 days
Rejection Criteria
Gross Hemolysis
Interference
Lack of N-terminal-pro brain natruretic peptide (NT-proBNP) elevations have been reported if congestive heart failure is very acute (first hour) or occurs with ventricular inflow obstruction (hypertrophic obstructive cardiomyopathy, mitral stenosis, atrial myxoma).
Useful For
​An aid in the diagnsis of congestive heart failure.
Reference Range Information
​Males​Females

< or =45 years: < or =51 pg/mL

46 years: < or =53 pg/mL

47 years: < or =55 pg/mL

48 years: < or =56 pg/mL

49 years: < or =58 pg/mL

50 years: < or =59 pg/mL

51 years: < or =61 pg/mL

52 years: < or =62 pg/mL

53 years: < or =64 pg/mL

54 years: < or =67 pg/mL

55 years: < or =68 pg/mL

56 years: < or =70 pg/mL

57 years: < or =71 pg/mL

58 years: < or =73 pg/mL

59 years: < or =76 pg/mL

60 years: < or =77 pg/mL

61 years: < or =79 pg/mL

62 years: < or =82 pg/mL

63 years: < or =83 pg/mL

64 years: < or =85 pg/mL

65 years: < or =88 pg/mL

66 years: < or =89 pg/mL

67 years: < or =92 pg/mL

68 years: < or =95 pg/mL

69 years: < or =97 pg/mL

70 years: < or =100 pg/mL

71 years: < or =103 pg/mL

72 years: < or =104 pg/mL

73 years: < or =107 pg/mL

74 years: < or =110 pg/mL

75 years: < or =113 pg/mL

76 years: < or =116 pg/mL

77 years: < or =119 pg/mL

78 years: < or =122 pg/mL

79 years: < or =125 pg/mL

80 years: < or =128 pg/mL

81 years: < or =131 pg/mL

82 years: < or =135 pg/mL

> or =83 years: < or =138 pg/mL

< or =46 years: < or =140 pg/mL

47 years: < or =141 pg/mL

48 years: < or =144 pg/mL

49 years: < or =146 pg/mL

50 years: < or =149 pg/mL

51 years: < or =150 pg/mL

52 years: < or =152 pg/mL

53 years: < or =155 pg/mL

54 years: < or =157 pg/mL

55 years: < or =160 pg/mL

56 years: < or =162 pg/mL

57 years: < or =166 pg/mL

58 years: < or =168 pg/mL

59 years: < or =171 pg/mL

60 years: < or =173 pg/mL

61 years: < or =177 pg/mL

62 years: < or =179 pg/mL

63 years: < or =183 pg/mL

64 years: < or =185 pg/mL

65 years: < or =189 pg/mL

66 years: < or =193 pg/mL

67 years: < or =196 pg/mL

68 years: < or =199 pg/mL

69 years: < or =202 pg/mL

70 years: < or =206 pg/mL

71 years: < or =210 pg/mL

72 years: < or =214 pg/mL

73 years: < or =218 pg/mL

74 years: < or =222 pg/mL

75 years: < or =227 pg/mL

76 years: < or =230 pg/mL

77 years: < or =235 pg/mL

78 years: < or =239 pg/mL

79 years: < or =244 pg/mL

80 years: < or =248 pg/mL

81 years: < or =253 pg/mL

82 years: < or =258 pg/mL

> or =83 years: < or =263 pg/mL

 

Interpretation

Under 50 years of age:

N-terminal pro brain 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 1,200 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 to 75 years of age:

NT-proBNP values below 300 pg/mL have a 99% negative predictive value for excluding acute CHF. A cutoff of 1,200 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 in adults 50 to 75 years of age in the absence of renal 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 1,200 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 1,800 pg/mL has been suggested in adults over 75 years of age in the absence of renal failure.

NT-Pro BNP levels are loosely correlated with New York Heart Association (NYHA) functional class

 
Interpretive Levels for CHF
Functional Class
5th to 95th Percentile
Median
I
31-1,110 pg/mL
377 pg/mL
II
55-4,975 pg/mL
1,223 pg/mL
III
77-26,916 pg/mL
3,130 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.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Sunday ​1-2 days ​Electrochemiluminescence Immunoassay (ECLIA)
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​83880
For most current information refer to the Marshfield Laboratory online reference manual.