title: Prognostic value of increased plasma levels of brain natriuretic peptide in patients with septic shock.
abstract: Our objective was to investigate the plasma levels of brain and atrial natriuretic peptides (BNP and ANP, respectively) in patients with septic shock/severe sepsis and to study the association of BNP and ANP levels with hemodynamic parameters, severity of the disease, and prognosis of those patients. This is a prospective case series study of 22 patients with septic shock, 11 patients with severe sepsis, and 20 healthy volunteers at the Department of Emergency and Critical Care Medicine, Nara Medical University Hospital, Japan. Blood collection was performed on admission and on days 1, 2, and 4. Plasma BNP and ANP levels were measured by radioimmunoassay. Right atrial pressure, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, and left ventricular stroke work index were determined using a thermodilution catheter. Acute Physiological and Chronic Health Evaluation II scores were calculated. Plasma levels of BNP and ANP were markedly elevated in patients with septic shock/severe sepsis compared with controls (BNP, 7 +/- 0.3 pg mL; ANP, 13 +/- 1 pg mL). In patients with septic shock, both BNP and ANP peaked on day 2 (BNP, 987 +/- 160 pg mL; ANP, 103 +/- 17 pg mL). Plasma levels of BNP on day 2 in patients with septic shock significantly correlated with right atrial pressure (r = 0.744, P < 0.01), mean pulmonary arterial pressure (r = 0.670, P < 0.01), pulmonary arterial wedge pressure (r = 0.709, P < 0.01), left ventricular stroke work index (r = -0.552, P < 0.05), Acute Physiological and Chronic Health Evaluation II score (r = 0.581, P < 0.01), and poor prognosis (P < 0.05). The optimal cutoff point for predicting mortality in patients with septic shock was a BNP level of 650 pg mL on day 2, in which sensitivity and specificity were 92% and 80%, respectively. Increased plasma levels of BNP may reflect not only the severity of myocardial depression but also the disease severity and could be of prognostic value in patients with septic shock.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ueda
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishio
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Akai
authors.forename: Hidetada
authors.initials: H
authors.lastname: Fukushima
authors.forename: Toru
authors.initials: T
authors.lastname: Ueyama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kawai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Masui
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshioka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Okuchi
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality* / Q000503:physiopathology
chemical_list: D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor