title: Analysis of N-terminal pro-B-type natriuretic peptide and cardiac index in multiple injured patients: a prospective cohort study.
abstract: BACKGROUND
  Increased serum B-type natriuretic peptide (BNP) has been identified for diagnosis and prognosis of impaired cardiac function in patients suffering from congestive heart failure, ischemic heart disease, and sepsis. However, the prognostic value of BNP in multiple injured patients developing multiple organ dysfunction syndrome (MODS) remains undetermined. Therefore, the aims of this study were to assess N-terminal pro-BNP (NT-proBNP) in multiple injured patients and to correlate the results with invasively assessed cardiac output and clinical signs of MODS.
  
  
  METHODS
  Twenty-six multiple injured patients presenting a New Injury Severity Score of greater than 16 points were included. The MODS score was calculated on admission as well as 24, 48, and 72 hours after injury. Patients were subdivided into groups: group A showed minor signs of organ dysfunction (MODS score less than or equal to 4 points) and group B suffered from major organ dysfunction (MODS score of greater than 4 points). Venous blood (5 mL) was collected after admission and 6, 12, 24, 48, and 72 hours after injury. NT-proBNP was determined using the Elecsys proBNP(R) assay. The hemodynamic monitoring of cardiac index (CI) was performed using transpulmonary thermodilution.
  
  
  RESULTS
  Serum NT-proBNP levels were elevated in all 26 patients. At admission, the serum NT-proBNP values were 116 +/- 21 pg/mL in group A versus 209 +/- 93 pg/mL in group B. NT-proBNP was significantly lower at all subsequent time points in group A in comparison with group B (P < 0.001). In contrast, the CI in group A was significantly higher than in group B at all time points (P < 0.001). Concerning MODS score and CI at 24, 48, and 72 hours after injury, an inverse correlation was found (r = -0.664, P < 0.001). Furthermore, a correlation was found comparing MODS score and serum NT-proBNP levels (r = 0.75, P < 0.0001).
  
  
  CONCLUSIONS
  Serum NT-proBNP levels significantly correlate with clinical signs of MODS 24 hours after multiple injury. Furthermore, a distinct correlation of serum NT-proBNP and decreased CI was found. The data of this pilot study may indicate a potential value of NT-proBNP in the diagnosis of post-traumatic cardiac impairment. However, further studies are needed to elucidate this issue.
authors.affiliation: Department of Orthopedic Sports Surgery, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, D-81675 Munich, Germany. chlodwig.kirchhoff@mac.com
authors.forename: Chlodwig
authors.initials: C
authors.lastname: Kirchhoff
authors.forename: Bernd A
authors.initials: BA
authors.lastname: Leidel
authors.forename: Sonja
authors.initials: S
authors.lastname: Kirchhoff
authors.forename: Volker
authors.initials: V
authors.lastname: Braunstein
authors.forename: Viktoria
authors.initials: V
authors.lastname: Bogner
authors.forename: Uwe
authors.initials: U
authors.lastname: Kreimeier
authors.forename: Wolf
authors.initials: W
authors.lastname: Mutschler
authors.forename: Peter
authors.initials: P
authors.lastname: Biberthaler
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output / Q000502:physiology*; D002306:Cardiac Volume / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood* / Q000175:diagnosis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010865:Pilot Projects; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D013577:Syndrome; D015599:Trauma Severity Indices; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
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