alpha-atrial natriuretic peptide, cyclic guanosine monophosphate, and endothelin in plasma as markers of myocardial depression in human septic shock.
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.
Hartemink
K J
KJ
Medical Intensive Care Unit, Institute for Cardiovascular Research and the Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Groeneveld
A B
AB
de Groot
M C
MC
Strack van Schijndel
R J
RJ
van Kamp
G
G
Thijs
L G
LG
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
D015415:Biomarkers; D016232:Endothelins; D009320:Atrial Natriuretic Factor; D006152:Cyclic GMP