title: Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis.
abstract: 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.
authors.affiliation: Medical Intensive Care Unit, Groupe Hospitalier Cochin-Saint Vincent de Paul-La Roche Guyon, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Fulla
authors.forename: Christophe
authors.initials: C
authors.lastname: Vinsonneau
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Sophie
authors.initials: S
authors.lastname: Grabar
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dhainaut
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
mesh_terms: 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
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain