Plasma atrial natriuretic peptide and brain natriuretic peptide are increased in septic shock: impact of interleukin-6 and sepsis-associated left ventricular dysfunction.
OBJECTIVE
Interest has recently focused on the use of neurohormonal markers such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) as indices of left ventricular systolic dysfunction and prognosis in heart failure. Also, peptides belonging to the interleukin-6 (IL-6) family have been shown to induce ANP and BNP secretion. We hypothesized that BNP and ANP spillover in the peripheral circulation reflects left ventricular dysfunction and IL-6 production in septic shock.


METHODS
Retrospective, clinical study in the medical intensive care unit of a university hospital.


METHODS
17 patients with septic shock and 19 control subjects.


METHODS
Collection of clinical and demographic data in relation to ANP, BNP, IL-6, and soluble TNF receptors (sTNF-R-p55, sTNF-R-p75) in plasma over a period of 4 days.


RESULTS
In septic shock we found a significant increase in ANP (82.7+/-9.9 vs. 14.9+/-1.2 pg/ml) and BNP (12.4+/-3.6 vs. 5.5+/-0.7 pg/ml). Plasma ANP peaked together with IL-6. Peaks of ANP and IL-6 were significantly correlated (r=0.73; p<0.01). BNP was inversely correlated to cardiac index (r=-0.56; p<0.05).


CONCLUSIONS
ANP and BNP increase significantly in patients with septic shock. BNP reflects left ventricular dysfunction. ANP is related to IL-6 production rather than to cardiovascular dysfunction.
Witthaut
Rochus
R
Department of Medicine III, Klinikum Kröllwitz, Martin Luther University, Ernst-Grube-Strasse 42, 06097 Halle, Germany. rochus.witthaut@medizin.uni-halle.de
Busch
Christian
C
Fraunberger
Peter
P
Walli
Autar
A
Seidel
Dietrich
D
Pilz
Günter
G
Stuttmann
Ralph
R
Speichermann
Norbert
N
Verner
Ljifane
L
Werdan
Karl
K
D009320:Atrial Natriuretic Factor / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000276:immunology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000276:immunology
D015850:Interleukin-6; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor