title: B-type natriuretic peptide levels may be elevated in the critically injured trauma patient without congestive heart failure.
abstract: BACKGROUND
  Rapid diagnosis of congestive heart failure (CHF) is essential to treatment. B-type natriuretic peptide (BNP) is a neurohormone secreted by the heart in response to fluid overload and has been shown to be elevated in medical patients with left ventricular dysfunction. However, BNP has not been evaluated in the critically ill patient with trauma.
  
  
  METHODS
  Trauma patients of at least 18 years of age with an expected intensive care unit stay of at least 24 hours were studied. Patients had BNP measurements at admission and at 24 hours and 48 hours. Echocardiography was performed within 48 hours of admission. CHF was determined by echocardiographic findings of systolic or diastolic dysfunction. Elevated BNP levels were defined as those greater than 100 pg/mL. A Fisher's exact test was performed to determine whether a relationship between BNP levels and echocardiographic findings existed. Linear correlation was used to determine whether BNP correlated with echocardiographic findings and initial Glasgow Coma Scores.
  
  
  RESULTS
  Fifty patients were included in the analysis. There was no relationship between elevated BNP levels and echocardiographic evidence of CHF (p = 0.149). There was no threshold value above which CHF was present. There were 28 patients with head injuries, and no relationship between BNP levels and CHF could be found (p = 0.432) in this group.
  
  
  CONCLUSIONS
  Our data show no association between BNP and CHF in the critically ill patient with trauma. BNP levels may be elevated in patients with head injuries without echocardiographic evidence of CHF.
authors: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
authors: David
authors: D
authors: Stewart
authors: Kenneth
authors: K
authors: Waxman
authors: C Alan
authors: CA
authors: Brown
authors: Rob
authors: R
authors: Schuster
authors: Lynn
authors: L
authors: Schuster
authors: Eva Marie
authors: EM
authors: Hvingelby
authors: Kelly
authors: K
authors: Kam
authors: Salvador
authors: S
authors: Becerra
mesh_terms: D000328:Adult; D016638:Critical Illness; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000378:metabolism*; D006801:Humans; D015601:Injury Severity Score; D020198:Intracranial Hemorrhage, Traumatic / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000145:classification / Q000378:metabolism*
chemical_list: D020097:Natriuretic Peptide, Brain