[Prognostic implication of plasma N-terminal-pro-brain natriuretic peptide in weaning from mechanical ventilation].
OBJECTIVE
To explore the relationship between plasma N-terminal-pro-brain natriuretic peptide (NT-proBNP) levels of patients before weaning and outcome of weaning from mechanical ventilation (MV) in patients.


METHODS
A total of 126 intensive care unit (ICU) patients with MV were enrolled from August 2008 to December 2009, and the cause composition was recorded. Plasma NT-proBNP levels were measured in patients with MV, in whom the clinical data had fulfilled the criteria for weaning from MV, spontaneous breathing trial, weaning and extubation were performed successively. The enrolled patients were divided into two groups namely success group and failure group according to weaning outcome within 48-hour. The plasma NT-proBNP levels in two groups were compared, and receiver operating characteristic (ROC) curve for predicted weaning outcome was plotted to find the cut-off point value of NT-proBNP.


RESULTS
The major causes of MV were pulmonary infection (33.3%) and surgical operations (30.2%), and heart failure accounted for only 11.9%. The plasma NT-proBNP levels before weaning were negatively correlated with the consequences of weaning. The plasma NT-proBNP levels in failure group (n=38) were significantly higher than those in success group (n=88, lg NT-proBNP: 3.97+/-0.48 vs. 2.99+/-0.67 ,P<0.05). The NT-proBNP area under ROC curve was 0.875+/-0.043 [95% confidence interval (95% CI) was 0.792-0.959]. The cut-off point value which could be used to predict the outcome of weaning was 3 914.5 ng/L. The sensitivity and specificity of the cut-off point value were 78.3% and 91.1%, respectively.


CONCLUSIONS
Irrespective of the causes of institution of MV, the cardiac function must be considered as an important factor in affecting the outcome of weaning. The plasma NT-proBNP level of 3 914.5 ng/L can be used to predict weaning outcome. The cardiac function should be improved to a point within the range of cut-off point value in order to improve the success rate of weaning.
Fang
Ming
M
Emergency and Critical Care Department, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China.
Hu
Bei
B
Li
Hui
H
Huang
Wei-ping
WP
Jiang
Wen-xin
WX
Zeng
Hong-ke
HK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012372:ROC Curve; D016896:Treatment Outcome; D015300:Ventilator Weaning
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain