Brain natriuretic peptide levels have diagnostic and prognostic capability for cardio-renal syndrome type 4 in intensive care unit patients.
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.
Park
Sunghoon
S
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
Cho
Goo-Yeong
GY
Kim
Sung Gyun
SG
Hwang
Yong Il
YI
Kang
Hye-Ryun
HR
Jang
Seung Hun
SH
Kim
Dong-Gyu
DG
Song
Young Rim
YR
Bae
Young-A
YA
Jung
Ki-Suck
KS
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
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain