title: Brain natriuretic peptide levels have diagnostic and prognostic capability for cardio-renal syndrome type 4 in intensive care unit patients.
abstract: BACKGROUND
  Limited data are available regarding the diagnostic and prognostic utility of brain natriuretic peptide (BNP) in patients with chronic kidney disease (CKD) in the intensive care unit (ICU) setting.
  
  
  METHODS
  All patients with CKD and a serum creatinine (Cr) of 2.0 mg/dl or higher admitted to the ICU between January 2006 and September 2007 were enrolled in this study. The CKD group was divided according to the presence or absence of acute decompensated heart failure (ADHF) into CKD + ADHF and CKD-ADHF groups, respectively. Other patients with ADHF having low Cr (<1.2 mg/dl) in the coronary care unit were also recruited as a control group during the same period. BNP levels at the time of admission (admission BNP) were compared amongst these groups. We then sought to determine whether BNP levels could predict the outcome in patients with CKD.
  
  
  RESULTS
  Of 136 patients with CKD for whom data were available, including 58 on dialysis (42.6%), 81 (59.6%) had ADHF and their estimated glomerular filtration rate (eGFR) was 12.8 +/- 7.3 ml/min/1.73 m2. BNP levels at admission were 2708.6 +/- 1246.9, 567.9 +/- 491.7 and 1418.9 +/- 1126.5 pg/ml in the CKD + ADHF, CKD - ADHF and control groups (n = 33), respectively (P = 0.000). The optimal cutoff level in patients with CKD was 1020.5 pg/ml (area under the curve = 0.944) to detect ADHF from the receiver operating characteristic (ROC) curve. This level was not associated with in-hospital mortality, all-cause death or a composite event (all-cause death and/or new cardiac event). However, a borderline significant association was observed with new cardiac events (hazard ratio (HR) = 4.551; P = 0.078) during the follow-up period (521.1 +/- 44.7 days). Furthermore, continuous variables of BNP and BNP quartiles were significantly associated with new cardiac events in the multivariate Cox model (HR = 1.001, P = 0.041; HR = 2.212, P = 0.018).
  
  
  CONCLUSIONS
  The findings suggest that the level of BNP at the time of admission may be a useful marker for detecting ADHF and predicting cardiac events in patients with CKD in the ICU setting.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Anyang, Kyunggi-do 431-070, Republic of Korea. f2000tj@gmail.com
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Park
authors.forename: Goo-Yeong
authors.initials: GY
authors.lastname: Cho
authors.forename: Sung Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Hwang
authors.forename: Hye-Ryun
authors.initials: HR
authors.lastname: Kang
authors.forename: Seung Hun
authors.initials: SH
authors.lastname: Jang
authors.forename: Dong-Gyu
authors.initials: DG
authors.lastname: Kim
authors.forename: Young Rim
authors.initials: YR
authors.lastname: Song
authors.forename: Young-A
authors.initials: YA
authors.lastname: Bae
authors.forename: Ki-Suck
authors.initials: KS
authors.lastname: Jung
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain