title: The role of brain natriuretic peptide in predicting renal outcome and fluid management in critically ill patients.
abstract: OBJECTIVE
  Fluid overload is associated with acute kidney injury (AKI) and mortality. There is no convenient precise method to guide fluid therapy in critically ill patients. We aimed to investigate whether brain natriuretic peptide (BNP) can predict the renal outcome and mortality of critically ill patients and be used to guide fluid management.
  
  
  METHODS
  This prospective observational study included patients who were admitted to the intensive care unit (ICU). Patients with underlying heart disease and heart dysfunction were excluded. Plasma BNP levels were obtained on admission (D0), at 24 hours (D1), and at 48 hours (D2). The primary outcome was AKI development during the ICU stay and recovery of AKI at ICU discharge. The secondary outcome was in-ICU mortality.
  
  
  RESULTS
  One hundred and sixty-three patients were enrolled for analysis. The delta-BNP level within the initial 24 hours after ICU admission rather than fluid accumulation was significantly correlated with delta-central venous pressure levels (r = 0.219, p = 0.010). Delta-Brain natriuretic peptide levels of < 81.8% within the initial 24 hours was an independent predictor of better renal outcome (i.e., no AKI or AKI with recovery). The increment in the BNP level from D0 to D1 was also a significant risk factor of mortality. In the a priori subgroup analysis for patients with sepsis, delta-BNP levels from D0 to D1 remained a significant predictor of renal outcome and mortality.
  
  
  CONCLUSIONS
  Our study showed that delta-BNP levels within 24 hours of admission to the ICU are better than fluid accumulation as a predictor of AKI, recovery, and mortality.
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan; Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Chou
authors.affiliation: Chest Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan.
authors.forename: Yen-Fu
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan; Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Szu-Yu
authors.initials: SY
authors.lastname: Pan
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan.
authors.forename: Tao-Min
authors.initials: TM
authors.lastname: Huang
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan.
authors.forename: Feng-Jung
authors.initials: FJ
authors.lastname: Yang
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan; Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Wen-Ching
authors.initials: WC
authors.lastname: Shen
authors.affiliation: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan; Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: chenym@ntuh.gov.tw.
authors.forename: Yung-Ming
authors.initials: YM
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood*; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: acute kidney injury; brain natriuretic peptide; fluid therapy; intensive care unit; mortality