title: alpha-atrial natriuretic peptide, cyclic guanosine monophosphate, and endothelin in plasma as markers of myocardial depression in human septic shock.
abstract: OBJECTIVE
  To assess the value of alpha-atrial natriuretic peptide (alpha-ANP), second messenger cyclic guanosine monophosphate (cGMP,) and endothelin as markers of myocardial depression in septic shock.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Medical intensive care unit (ICU) of a university hospital.
  
  
  METHODS
  Fourteen consecutive patients with septic shock and arterial and pulmonary artery catheters in place.
  
  
  RESULTS
  Hemodynamic variables and plasma levels of alpha-ANP, cGMP, and endothelin were measured every 6 hrs for 3 days after admission. Eight patients died from shock in the ICU. The nadir left ventricular stroke work index (LVSWI) was below 35 g/m2 in all patients, and the median peak circulating alpha-ANP (n < 68 pg/mL) was 276 pg/mL (range, 79-1056), the median peak cGMP (n < 2.1 ng/mL) was 8.1 ng/mL (range, 3.2-29.7), and the median peak endothelin (n < 5.3 pg/mL) was 15.5 pg/mL (range, 8.5-33.9), supranormal in all patients. Outcome groups differed in the course of cardiac index and LVSWI, which were lower in nonsurvivors despite similar filling pressures and more intensive inotropic treatment (p < .01). The course of alpha-ANP, cGMP, and endothelin plasma levels also differed between groups, with higher levels in nonsurvivors (p < .05). As for pooled data, the mean daily or nadir LVSWI inversely related to mean daily or peak alpha-ANP, cGMP, and endothelin levels, respectively (p < .05). The area under the receiver operating characteristic curve for myocardial depression (LVSWI < 35 g/m2) was for alpha-ANP and endothelin 0.77, and for cGMP 0.85 (p < .01). The optimum cutoff values for alpha-ANP, cGMP, and endothelin were 172 pg/mL, 4.5 ng/mL, and 10.0 pg/mL, respectively. The sensitivity for myocardial depression of alpha-ANP, cGMP, and endothelin was 68%, 77%, and 72%, and the specificity was 82%, 93%, and 69%, respectively.
  
  
  CONCLUSIONS
  Circulating alpha-ANP, endothelin, and, particularly, cGMP may be markers of the myocardial depression of human septic shock, which is associated with mortality.
authors.affiliation: Medical Intensive Care Unit, Institute for Cardiovascular Research and the Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: Hartemink
authors.forename: A B
authors.initials: AB
authors.lastname: Groeneveld
authors.forename: M C
authors.initials: MC
authors.lastname: de Groot
authors.forename: R J
authors.initials: RJ
authors.lastname: Strack van Schijndel
authors.forename: G
authors.initials: G
authors.lastname: van Kamp
authors.forename: L G
authors.initials: LG
authors.lastname: Thijs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006152:Cyclic GMP / Q000097:blood*; D016232:Endothelins / Q000097:blood*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D015656:Respiratory Mechanics; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000150:complications* / Q000401:mortality; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016276:Ventricular Function
chemical_list: D015415:Biomarkers; D016232:Endothelins; D009320:Atrial Natriuretic Factor; D006152:Cyclic GMP