title: Positive end-expiratory pressure and renal function influence B-type natriuretic peptide in patients with severe sepsis and septic shock.
abstract: BACKGROUND
  Myocardial dysfunction is a complication associated with a poor prognosis in septic patients. A biomarker of cardiac function providing prognostic information is of paramount interest.
  
  
  OBJECTIVE
  We sought to determine the value of B-type natriuretic peptide in patients with severe sepsis/septic shock.
  
  
  METHODS
  We performed a prospective study in patients with severe sepsis/septic shock in a medical intensive care unit. B-type natriuretic peptide level was determined within 24 hours after the diagnosis of severe sepsis/septic shock. We also analyzed mortality, and presence of association between B-type natriuretic peptide and clinical, hemodynamic and respiratory variables.
  
  
  RESULTS
  23 (9 women; 14 men) patients with ages ranging from 20-79 (mean 51.3+/-18.6) years old and APACHE score of 22.6+/-11.8 were included; 15 (65.2%) patients received pulmonary artery catheters, and 20 (87%) were mechanically ventilated. Multivariate analysis disclosed inverse association between B-type natriuretic peptide values with positive end-expiratory pressure values, and direct association with creatinine (beta 0.548 and 0.377, p 0.02 and 0.002, respectively), but not with mortality, clinical and hemodynamic parameters.
  
  
  CONCLUSIONS
  This is the first report on an inverse association between positive end-expiratory pressure and BNP levels in patients with severe sepsis and septic shock. BNP and creatinine levels should be taken into consideration when analyzing B-type natriuretic peptide levels in this setting.
authors: Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil. victorissa@cardiol.br
authors: Victor Sarli
authors: VS
authors: Issa
authors: Leandro Utino
authors: LU
authors: Taniguchi
authors: Marcelo
authors: M
authors: Park
authors: Luiz Monteiro
authors: LM
authors: Cruz
authors: Edimar Alcides
authors: EA
authors: Bocchi
authors: Irineu Tadeu
authors: IT
authors: Velasco
authors: Francisco
authors: F
authors: Soriano
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011175:Positive-Pressure Respiration; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000401:mortality; D012772:Shock, Septic / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D003404:Creatinine