title: Increased B-type natriuretic peptide and decreased proteinuria might reflect decreased capillary leakage and is associated with a better outcome in patients with severe burns.
abstract: BACKGROUND
  It is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate to systemic capillary leakage. This study investigates whether combining BNP and proteinuria can be used as a guide for individualized resuscitation and as a predictor of outcome in patients with severe burns.
  
  
  METHODS
  From 2006 to 2009, 38 consecutive patients (age 47 ± 15 years, 74% male) with severe burns were included and followed for 20 days. All had normal kidney function at admission. BNP and proteinuria were routinely measured. Ordered and actually administered fluid resuscitation volumes were recorded. The Sequential Organ Failure Assessment (SOFA) score was used as the measure of outcome.
  
  
  RESULTS
  BNP increased during follow-up, reaching a plateau level at Day 3. Based on median BNP levels at Day 3, patients were divided into those with low BNP and those with high BNP levels. Both groups had comparable initial SOFA scores. Patients with high BNP received less fluid from Days 3 to 10. Furthermore, patients with a high BNP at Day 3 had less morbidity, reflected by lower SOFA scores on the following days. To minimize effects of biological variability, proteinuria on Days 1 and 2 was averaged. By dividing the patients based on median BNP at Day 3 and median proteinuria, patients with high BNP and low proteinuria had significantly lower SOFA scores during the entire follow-up period compared to those patients with low BNP and high proteinuria.
  
  
  CONCLUSIONS
  Patients with higher BNP levels received less fluid. This might be explained by a lower capillary leakage in these patients, resulting in more intravascular fluid and consequently an increase in BNP. In combination with low proteinuria, possibly reflecting minimal systemic capillary leakage, a high BNP level was associated with a better outcome. BNP and proteinuria have prognostic potential in severely burned patients and may be used to adjust individual resuscitation.
authors: Department of Internal Medicine, Martini Hospital, van Swietenplein 1, 9700 RM Groningen, The Netherlands. k.de.leeuw@mzh.nl
authors: Karina
authors: K
authors: de Leeuw
authors: Marianne K
authors: MK
authors: Nieuwenhuis
authors: Anuschka S
authors: AS
authors: Niemeijer
authors: Hans
authors: H
authors: Eshuis
authors: Gerard I J M
authors: GI
authors: Beerthuizen
authors: Wilbert M
authors: WM
authors: Janssen
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002056:Burns / Q000097:blood / Q000503:physiopathology*; D019559:Capillary Leak Syndrome / Q000503:physiopathology*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D011507:Proteinuria / Q000097:blood*; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014882:Water-Electrolyte Balance / Q000502:physiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain