Utility of B-type natriuretic peptide for the evaluation of intensive care unit shock.
OBJECTIVE
Among patients with congestive heart failure, B-type natriuretic peptide measurement is useful to estimate filling pressures and to prognosticate adverse outcome. However, among critically ill intensive care unit patients with shock, the utility of B-type natriuretic peptide to assess cardiac hemodynamics or prognosis has not been explored.


METHODS
Clinical investigation.


METHODS
Hospital.


METHODS
Forty-nine patients with shock and indication for pulmonary artery catheterization.


METHODS
Analysis for B-type natriuretic peptide was performed on blood obtained at the time of catheter placement.


RESULTS
Correlations between B-type natriuretic peptide and pulmonary artery occlusion pressure as well as cardiac index were calculated using Spearman analysis. Mortality at the time of study completion was correlated with B-type natriuretic peptide values and Acute Physiology and Chronic Health Evaluation II scores, and logistic regression identified independent predictors of mortality. A wide range of B-type natriuretic peptide concentrations was seen in intensive care unit patients (<5 to >5000 pg/mL); only eight patients (16%) had normal B-type natriuretic peptide concentrations. Log-transformed B-type natriuretic peptide concentrations did not correlate with interpatient cardiac index or pulmonary artery occlusion pressure (all p = not significant); however, a B-type natriuretic peptide <350 pg/mL had a negative predictive value of 95% for the diagnosis of cardiogenic shock. Median B-type natriuretic peptide concentrations were higher in those who died than those who survived (943 pg/mL vs. 378 pg/mL, p <.001). In multivariable analysis, a B-type natriuretic peptide concentration in the highest log-quartile was the strongest predictor of mortality (odds ratio = 4.50, 95% confidence interval = 1.87-99.0, p <.001).


CONCLUSIONS
B-type natriuretic peptide concentrations are frequently elevated among critically ill patients in the intensive care unit and cannot be used as a surrogate for pulmonary artery catheterization. B-type natriuretic peptide concentrations in intensive care unit shock may provide powerful information for use in mortality prediction.
Department of Medicine, Massachusetts General Hospital, Boston, MA.
Roderick H
RH
Tung
Christine
C
Garcia
Alexander M
AM
Morss
Richard M
RM
Pino
Michael A
MA
Fifer
B Taylor
BT
Thompson
Kent
K
Lewandrowski
Elizabeth
E
Lee-Lewandrowski
James L
JL
Januzzi
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002407:Catheterization, Swan-Ganz; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012769:Shock / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain