title: Plasma brain natriuretic peptide and troponin levels in severe sepsis and septic shock: relationships with systolic myocardial dysfunction and intensive care unit mortality.
abstract: The aim of this study was to evaluate and compare brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels as mortality prognosticator and predictor for myocardial dysfunction in severe sepsis and septic shock. Baseline clinical and biological variables were collected from 47 patients with severe sepsis or septic shock. Ventricular systolic function assessed by echocardiography was measured over a 5-day period. Both cTnI and BNP plasmatic levels were determined at intensive care unit (ICU) admission and during the following 15 days. At admission, cTnI and BNP levels were compared to those of 12 control critically ill nonseptic patients. The plasma levels of BNP and cTnI in patients with sepsis were elevated at admission and significantly higher than in the controls. Among patients with sepsis, BNP levels were significantly more elevated in nonsurvivors compared to survivors at admission and 1 day later. The cTnI levels were also significantly more elevated in nonsurvivors compared to survivors, but only at admission. From admission to day 5, patients with sepsis with left ventricular systolic dysfunction had higher BNP plasmatic concentrations than those without; differences were significant at days 3 and 4. In contrast, plasma cTnI levels were similar between the 2 groups. In critically ill patients, sepsis induces significant increase in BNP and cTnI levels. High BNP and cTnI plasma levels during ICU admission appear to be associated with poor outcome of sepsis. Time course of BNP levels seems helpful to discriminate between surviving and nonsurviving patients with sepsis and to detect myocardial dysfunction where troponin levels fail to do so.
authors.affiliation: Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France k-klouche@chu-montpellier.fr.
authors.forename: Kada
authors.initials: K
authors.lastname: Klouche
authors.affiliation: Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Pommet
authors.affiliation: Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Amigues
authors.affiliation: Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Bargnoux
authors.affiliation: Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Dupuy
authors.affiliation: Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Machado
authors.affiliation: Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Serveaux-Delous
authors.affiliation: Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Morena
authors.affiliation: Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Jonquet
authors.affiliation: Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Cristol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D018805:Sepsis / Q000097:blood*; D012772:Shock, Septic / Q000097:blood*; D019210:Troponin I / Q000097:blood*; D018487:Ventricular Dysfunction, Left; D055815:Young Adult
chemical_list: D019210:Troponin I; D020097:Natriuretic Peptide, Brain
keywords: biomarkers; brain natriuretic peptide; myocardial dysfunction; septic shock; severe sepsis; troponin