Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis.
OBJECTIVE
To investigate the value of brain natriuretic peptide plasma levels as a marker of systolic myocardial dysfunction during severe sepsis and septic shock.


METHODS
Prospective observational study.


METHODS
Intensive care unit.


METHODS
A total of 34 consecutive patients with severe sepsis (nine patients) or septic shock (25 patients) without previous cardiac, respiratory, or chronic renal failure.


METHODS
None.


RESULTS
Myocardial systolic performance was assessed by fractional area contraction (FAC) using echocardiography performed on days 2 (FACD2) and 8. Plasma levels of brain natriuretic peptide were measured at days 1-4 and 8 after the beginning of severe sepsis. Among 34 patients (Simplified Acute Physiology Score II, 43 +/- 2.5), 15 (44%) presented with initial myocardial dysfunction (FACD2 < 50%). Lungs were the origin of sepsis in 65% of patients. The 28-day mortality was 29%. Comparisons were performed between patients with (FACD2 < 50%) and without (FACD2 > or = 50%) myocardial dysfunction. Plasma levels of brain natriuretic peptide were significantly higher in patients with FACD2 < 50% than in those with FACD2 > or = 50% (p <.05) from day 2 to day 4. Brain natriuretic peptide levels were also significantly higher on days 2 and 3 in patients who died during their intensive care unit stay (p <.05).


CONCLUSIONS
Systolic myocardial dysfunction is present in 44% of patient with severe sepsis or septic shock. In this setting, brain natriuretic peptide seems useful to detect myocardial dysfunction, and high plasma levels appear to be associated with poor outcome of sepsis, but further studies are needed.
Charpentier
Julien
J
Medical Intensive Care Unit, Groupe Hospitalier Cochin-Saint Vincent de Paul-La Roche Guyon, Paris, France.
Luyt
Charles-Edouard
CE
Fulla
Yvonne
Y
Vinsonneau
Christophe
C
Cariou
Alain
A
Grabar
Sophie
S
Dhainaut
Jean-François
JF
Mira
Jean-Paul
JP
Chiche
Jean-Daniel
JD
D000704:Analysis of Variance; D015415:Biomarkers; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019370:Observation; D010297:Paris / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000401:mortality; D012772:Shock, Septic / Q000150:complications / Q000401:mortality; D016019:Survival Analysis
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain