title: Prognostic value of plasma N-terminal probrain natriuretic peptide levels in the acute respiratory distress syndrome.
abstract: OBJECTIVE
  Patients with acute respiratory distress syndrome suffer from profound cardiac and pulmonary derangement, including right ventricular strain and noncardiogenic pulmonary edema, which may potentially alter concentrations of cardiac natriuretic peptides. We sought to determine whether N-terminal probrain natriuretic peptide (NT-proBNP) levels are elevated in acute respiratory distress syndrome and whether they can serve as a marker of prognosis in this setting.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary-care academic medical center.
  
  
  METHODS
  One hundred seventy-seven acute respiratory distress syndrome subjects enrolled in a prospective intensive care unit cohort.
  
  
  METHODS
  None.
  
  
  RESULTS
  NT-proBNP was measured from blood taken within 48 hrs of acute respiratory distress syndrome onset. Patients were followed for the primary outcome of 60-day mortality and secondary outcomes of organ dysfunction and ventilator-free days. Seventy patients died (40%). Median NT-proBNP level was 3181 ng/L (interquartile range 723-9246 ng/L). NT-proBNP levels were significantly higher among nonsurvivors (p < .0001). Receiver operating curve analysis revealed an optimal NT-proBNP cut-point of 6813 ng/L for predicting death. Patients with levels above the cut-point had significantly higher odds of mortality on multivariable analysis (odds ratio 2.36, 95% confidence interval 1.11-4.99, p = .02) than those with levels below the cut-point. Kaplan-Meier survival analysis showed that this difference emerged early and was sustained (p < .0001). Patients with elevated NT-proBNP also had higher organ dysfunction scores (p < .0001) and fewer ventilator free days (p = .03) than those with lower NT-proBNP levels.
  
  
  CONCLUSIONS
  NT-proBNP levels are elevated among acute respiratory distress syndrome patients and parallel the severity of the syndrome and likelihood for morbidity and mortality. This demonstrates the potential utility of this biomarker for prognosis in this disease.
authors.affiliation: Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. ebajwa@partners.org
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
mesh_terms: D018806:APACHE; D000368:Aged; D015415:Biomarkers; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain