title: Sequential N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin Measurements During Albumin Replacement in Patients With Severe Sepsis or Septic Shock.
abstract: OBJECTIVE
  Myocardial dysfunction is a frequent complication in patients with severe sepsis and can worsen the prognosis. We investigated whether circulating biomarkers related to myocardial function and injury predicted outcome and were associated with albumin replacement.
  
  
  METHODS
  A multicenter, randomized clinical trial about albumin replacement in severe sepsis or septic shock (the Albumin Italian Outcome Sepsis trial).
  
  
  METHODS
  Forty ICUs in Italy.
  
  
  METHODS
  Nine hundred and ninety-five patients with severe sepsis or septic shock.
  
  
  METHODS
  Randomization to albumin and crystalloid solutions or crystalloid solutions alone.
  
  
  RESULTS
  Plasma concentrations of N- terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T were measured 1, 2, and 7 days after enrollment. We tested the relationship of single marker measurements or changes over time with clinical events, organ dysfunctions, albumin replacement, and ICU or 90-day mortality in the overall population and after stratification by shock. N-terminal pro-B-type natriuretic peptide levels were abnormal in 97.4% of the patients and high-sensitivity cardiac troponin T in 84.5%, with higher concentrations in those with shock. After extensive adjustments, N-terminal pro-B-type natriuretic peptide concentrations predicted ICU or 90-day mortality, better than high-sensitivity cardiac troponin T. Early changes in N-terminal pro-B-type natriuretic peptide or high-sensitivity cardiac troponin T concentrations were independently associated with subsequent mortality in patients with shock. Patients given albumin had significantly higher N-terminal pro-B-type natriuretic peptide levels; in addition, early rise in N-terminal pro-B-type natriuretic peptide was associated with a better outcome in this subgroup.
  
  
  CONCLUSIONS
  Circulating N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T are frequently elevated in severe sepsis or septic shock and have relevant prognostic value, which may be important in monitoring the clinical efficacy of supporting therapy.
authors.affiliation: 1Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. 2Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. 3Dipartimento di Anestesia, Rianimazione, ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. 4Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy. 5Dipartimento di Anestesia, Rianimazione, Terapia del Dolore e Cure Palliative A.O. Salvini-Ospedale di Circolo, Rho, Italy. 6Istituto di Anestesiologia e Rianimazione, Università Cattolica-Policlinico Universitario A. Gemelli, Rome, Italy. 7UO Anestesia e Rianimazione, AO Ospedale Civile di Legnano, Legnano, Italy. 8Laboratory of Endocrinology, Ospedale Luigi Sacco, Milan, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.forename: Pietro
authors.initials: P
authors.lastname: Caironi
authors.forename: Caterina
authors.initials: C
authors.lastname: Fanizza
authors.forename: Sara
authors.initials: S
authors.lastname: Carrer
authors.forename: Anselmo
authors.initials: A
authors.lastname: Caricato
authors.forename: Paola
authors.initials: P
authors.lastname: Fassini
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Vago
authors.forename: Marilena
authors.initials: M
authors.lastname: Romero
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D000077324:Crystalloid Solutions; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units; D007552:Isotonic Solutions; D007558:Italy; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D018805:Sepsis / Q000097:blood / Q000628:therapy; D012709:Serum Albumin / Q000032:analysis*; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality / Q000628:therapy; D014336:Troponin / Q000097:blood*
chemical_list: D000418:Albumins; D015415:Biomarkers; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010446:Peptide Fragments; D012709:Serum Albumin; D014336:Troponin; D020097:Natriuretic Peptide, Brain