title: NH2 terminal pro-brain natriuretic peptide plasma level as an early marker of prognosis and cardiac dysfunction in septic shock patients.
abstract: OBJECTIVE
  To investigate N-terminal pro-brain natriuretic peptide (NT-proBNP) level as a prognostic factor and a marker of myocardial dysfunction in patients with septic shock.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Intensive care unit.
  
  
  METHODS
  A total of 39 patients diagnosed with septic shock and requiring mechanical ventilation.
  
  
  RESULTS
  Demographic, hemodynamic, respiratory, and biological data (notably NT-proBNP, lactate, and cardiac troponin I) were collected at inclusion and every 12 hrs. The independent factors for death were higher Sequential Organ Failure Assessment score in the 24-hr period after inclusion (odds ratio, 4.7; 95% confidence interval, 1.15-19.3) and the highest NT-proBNP level in the 24-hr period after inclusion (odds ratio, 1.12 per 1000 pg/mL increase; 95% confidence interval, 1.05-1.26). An NT-proBNP of >13,600 pg/mL predicted intensive care unit mortality with an accuracy of 77%. Area under the receiver operating characteristic curve was 0.8 (p = .002; 95% confidence interval, 0.66-0.93). NT-proBNP levels were over the accepted normal range in all patients. Values were highest between 24 and 36 hrs after onset of septic shock and were significantly higher in nonsurvivors at each time between inclusion and day 7. The lowest left ventricular stroke work index of the first 24-hr period after inclusion was the only factor that independently influenced higher NT-proBNP levels at the same time (odds ratio, 0.91; 95% confidence interval, 0.84-0.98).
  
  
  CONCLUSIONS
  NT-proBNP seems to be an early factor of prognosis and myocardial dysfunction in patients with septic shock.
authors.affiliation: Service de Réanimation Polyvalente, Hôpitaux Sud, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.forename: Jérôme
authors.initials: J
authors.lastname: Allardet-Servent
authors.forename: Pierre
authors.initials: P
authors.lastname: Michelet
authors.forename: Christiane
authors.initials: C
authors.lastname: Oddoze
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.forename: Karine
authors.initials: K
authors.lastname: Barrau
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.forename: Gilles
authors.initials: G
authors.lastname: Perrin
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Auffray
authors.forename: Henri
authors.initials: H
authors.lastname: Portugal
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D000368:Aged; D001794:Blood Pressure; D009202:Cardiomyopathies / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality / Q000628:therapy; D019210:Troponin I / Q000097:blood*
chemical_list: D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain