Test Catalog

Test Id : PBNP1

NT-Pro B-Type Natriuretic Peptide, Serum

Useful For
Suggests clinical disorders or settings where the test may be helpful

Aids in the diagnosis of congestive heart failure using serum specimens

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

Electrochemiluminescence Immunoassay

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

NT-Pro BNP, S

Aliases
Lists additional common names for a test, as an aid in searching

ProBNP (B-Type Natriuretic Peptide)

NT Pro BNP

N Terminal proBNP

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Specimen Type
Describes the specimen type validated for testing

Serum

Necessary Information

Patient's age and sex are required.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

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.

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 aliquoted within 2 hours of collection.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.3 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Frozen (preferred) 365 days
Refrigerated 7 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Aids in the diagnosis of congestive heart failure using serum specimens

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

B-type natriuretic peptide (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
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

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: < or =157 pg/mL

15 years-18 years: < or =158 pg/mL

19-39 years: <79 pg/mL

40-44 years: < or =72 pg/mL

45-54 years: < or =87 pg/mL

55-64 years: < or =88 pg/mL

> or =65 years: < or =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: < or =158 pg/mL

19-39 years: <160 pg/mL

40-44 years: < or =162 pg/mL

45-54 years: < or =141 pg/mL

55-64 years: < or =226 pg/mL

> or =65 years: < or =540 pg/mL

Interpretation
Provides information to assist in interpretation of the test results

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 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 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 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 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 (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.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

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).

Clinical Reference
Recommendations for in-depth reading of a clinical nature

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 Feb;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 Aug 1;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 Feb 4;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

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

This is an automated, double-incubation sandwich assay. In the first incubation, antigen from the patient specimen reacts with biotinylated monoclonal sheep N-terminal pro brain natriuretic peptide (NT-proBNP) antibody and monoclonal NT-proBNP antibody labeled with ruthenium complex. During the second incubation, streptavidin-labeled microparticles are added, and the resulting complex is bound to the solid-phase via biotin-streptavidin interaction. The resulting reaction mixture is aspirated into the measuring cell where the microparticles are magnetically captured onto the surface of an electrode. Unbound substances are washed away. Voltage is then applied to the electrode, which induces chemiluminescent emission that is measured by a photomultiplier. Results are obtained by comparing this measurement against the calibration curve. The Roche E Modular NT-proBNP assay standardization is traceable to an internal Roche standard. Assigned values for calibrators are traceable to this standardization.

 

The Roche NT-proBNP assay is automated and more precise than the Biosite BNP assay used previously. In addition, in vitro NT-proBNP is more stable than BNP.(Package insert: ProBNP II, Roche Diagnostics; V 12.0. 07/2021)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

Same day/1 to 2 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

83880

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
PBNP1 NT-Pro BNP, S 83107-3
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
PBNP1 NT-Pro BNP, S 83107-3

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
New Test 2022-06-21