B-type natriuretic peptide levels may be elevated in the critically injured trauma patient without congestive heart failure.
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.
Stewart
David
D
Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
Waxman
Kenneth
K
Brown
C Alan
CA
Schuster
Rob
R
Schuster
Lynn
L
Hvingelby
Eva Marie
EM
Kam
Kelly
K
Becerra
Salvador
S
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*
D020097:Natriuretic Peptide, Brain