atrial-natriuretic-factor and Burns

To identify the dynamic response of hormones after burns with special reference to ANP during shock and the subsequent period, plasma concentrations of atrial natriuretic peptide (ANP), aldosterone, cortisol, arginine vasopressin (AVP), corticotropin, (ACTH), plasma renin activities (PRA), norepinephrine (NE) and epinephrine (E) were measured from the day of ICU admission and for 7 days following burn injury. Plasma AVP levels were highest on ICU admission and correlated with size of the burn injury ranged from 20-60 percent of the total body surface area. Between the 5th and 6th postburn day plasma ANP levels elevated while plasma AVP levels returned to normal. Urine sodium concentrations decreased from the 3rd day. Plasma aldosterone levels declined after the 2nd day. Mean epinephrine (E) and norepinephrine (NE) levels elevated on admission and remained elevated throughout the study. These results suggest that ANP plays important role for restoring fluid homeostasis by improving edema in burned tissues during refilling periods in burns.

Topics: Adrenocorticotropic Hormone; Aged; Aldosterone; Arginine Vasopressin; Atrial Natriuretic Factor; Burns; Epinephrine; Female; Humans; Hydrocortisone; Middle Aged; Norepinephrine; Osmolar Concentration; Renin; Sodium

The significance of the validated biomarkers of sepsis Mid-regional pro-atrial natriuretic peptide (MR-proANP) and copeptin have not been tested in a burn injury setting.. 42 consecutive patients were included in a prospective observational study. Daily blood specimens collected over the initial 20 days of treatment were quantitatively analysed by immunoluminometric sandwich assay (Kryptor, BRAHMS, Berlin, Germany) for MR-proANP, copeptin and procalcitonin (PCT).. In patients with absence of sepsis, copeptin levels initially increased post-burn injury and thereafter rapidly declined. In contrast, MR-proANP was only slightly elevated within the first few days. MR-proANP [199.8 (115.6; 399.5) vs 160.1 (93.7; 280.6), P < .007] and PCT [1.12 (0.32; 2.22) vs 0.32 (0.16; 0.53), P < .001] levels were significantly higher on days of sepsis. Copeptin, however, showed no significant differences [20.7 (11.8; 42.2) vs 16.8 (11.0; 30.6), P = .11]. Both, MR-proANP and PCT level increases were noted upon the first day of sepsis.. Burn injury itself maybe associated with copeptin and to a lesser degree MR-proANP level increases. Subsequent increases in MR-proANP may be considered diagnostic for sepsis but demonstrated no advantages over PCT. The role of copeptin remains inappropriate for diagnosing sepsis after burn injury (ClinicalTrials.gov number, NCT01055587).

Topics: Adult; Aged; Atrial Natriuretic Factor; Biomarkers; Burns; Female; Glycopeptides; Humans; Male; Middle Aged; Prospective Studies; Sepsis

The aim of this study was to determine whether systemic inflammatory response syndrome (SIRS) in burn patients is mediated by the brain natriuretic peptide (BNP)/natriuretic peptide A receptor (NPRA)-induced heat shock factor 1 (HSF-1) signalling pathway. Mononuclear cells (MNCs) that were isolated from patients with burn injuries and SIRS mouse models and a RAW264.7 cell line were treated with normal serum or serum obtained from animals with burn injuries. In parallel, small hairpin RNAs (shRNAs) against BNP or NPRA were transfected in both cell types. Western blotting (WB) and enzyme-linked immunosorbent assay (ELISA) were used to detect protein expression and inflammatory factor levels, respectively. We found that interleukin (IL)-12, tumour necrosis factor (TNF)-α, C-reactive protein (CRP), and BNP levels were increased and IL-10 levels were decreased in the plasma and MNCs in vivo in the animal model of SIRS. Additionally, NPRA was upregulated, whereas HSF-1 was downregulated in monocytes in vivo. Treatment of RAW264.7 cells with burn serum or BNP induced IL-12, TNF-α, and CRP secretion as well as HSF-1 expression. Finally, silencing BNP with shRNA interrupted the effect of burn serum on RAW264.7 cells, and silencing NPRA blocked burn serum- and BNP-mediated changes in RAW264.7 cells. These results suggest that the interaction of NPRA with BNP secreted from circulatory MNCs as well as mononuclear macrophages leads to inflammation via HSF-1 during SIRS development following serious burn injury.

Topics: Animals; Atrial Natriuretic Factor; Biomarkers; Burns; Cell Line; DNA-Binding Proteins; Heat Shock Transcription Factors; Male; Mice; Mice, Inbred C57BL; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Protein Precursors; Rats; Rats, Sprague-Dawley; Signal Transduction; Systemic Inflammatory Response Syndrome; Transcription Factors

Plasma atrial natriuretic peptide levels (proANP (1-98)), a parameter of myocardial dysfunction, have been reported to be increased in critically ill patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The aim of the study was to examine if proANP is a biomarker of ALI/ARDS as assessed by the Sequential Organ Failure Assessment score (SOFA Lung ≥2) in burn patients, and how it compares to the corresponding values for age, total body surface area percent (TBSA%) and inhalation injury for mortality prediction.. A group of 22 burn patients with a mean TBSA of 30% (10-75%) and a mean age of 52 years (25-84 years) was investigated during 2010. Organ dysfunction/failure was classified according to the SOFA score. The criteria for ALI/ARDS were based on SOFA Lung ≥2. ProANP (1-98) concentrations (nmoll(-1)) were measured by commercially available enzyme linked immunosorbent assay (ELISA) immunoassays (Biomedica Austria) on post-burn days 2 and 7.. ProANP levels on day 7 post-burn positively correlated with a SOFA score day 7 post-burn, c=0.91. The receiver operating curve (ROC) analysis proved a sensitivity of 75% and a specificity of 75% for ALI/ARDS at cut-off values >3.35 nmoll(-1). The ROC value of proANP for ALI/ARDS (SOFA Lung ≥2) was significantly larger than that of age, TBSA% and inhalation injury: 0.90, 0.71, 0.74, and 0.69 (p<0.001).. ProANP levels, as a biomarker of ALI/ARDS, in critically burn patients correlated with SOFA scoring. The inhalation injury did not lead to increase in proANP values.

Topics: Acute Lung Injury; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Burns; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Middle Aged; Regression Analysis; Respiratory Distress Syndrome; ROC Curve; Sensitivity and Specificity

The typical response to burn stress causes burn shock, followed by a diuretic phase; however, fluid management remains crucial in this phase in the treatment of the elderly, patients with preexisting cardiac or renal diseases, and patients developing acute renal failure. We studied the effects of human atrial natriuretic peptide (hANP), which is a renal vasodilator, natriuretic, and inhibitor of renin secretion, on renal function in these patients with burn injuries.. Thirty-three severely burned patients (44.8% +/- 20.6% total burn surface area) with prolonged cardiovascular overload and pulmonary edema after burn shock receiving a continuous infusion of hANP (0.025 microg/kg/min and 0.05 microg/kg/min, hANP group) were compared with control (no-hANP group, n = 25). Vital signs, urine output (UO) and blood gas analysis before and 72 hour after the start of hANP were recorded. Creatinine clearance, free water clearance, and fractional excretion of sodium were also calculated.. Sixteen (48%) patients were elderly, over 80 years old. Twenty (60%) had preexisting cardiovascular disease, renal insufficiency, or diabetes. hANP infusion increased UO in 25 (66%) cases and improved oxygenation in 31 (82%) cases. Treatment with hANP increased creatinine clearance, fractional excretion of sodium, and UO, except in four cases that had already progressed to complete renal failure before the infusion of hANP.. Intravenous hANP seems to be effective for postresuscitative pulmonary dysfunction and renal function after burn shock in the vulnerable elderly, or patients with preexisting disease, suggesting that it could be valuable in facilitating fluid management in the acute phase in severely burned patients.

Topics: Age Factors; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Blood Gas Analysis; Burn Units; Burns; Case-Control Studies; Chi-Square Distribution; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Injury Severity Score; Kidney; Kidney Function Tests; Lung; Male; Middle Aged; Probability; Respiratory Function Tests; Respiratory Mechanics; Risk Assessment; Shock, Traumatic; Statistics, Nonparametric; Survival Analysis

Markedly elevated levels of plasma atrial natriuretic peptide (ANP), which exhibit potent diuretic and vasoactive properties, has been well documented in patients with acute lung injury. We examined the physiological effects of additional smoke inhalation on plasma ANP concentrations in an ovine burn model. Seventeen sheep were instrumented to receive fluid and have physiological measurements taken. The burn group (n=8) received 40% body surface area third degree burn and the burn+smoke group (n=9) received the same burn plus 48 breaths of cotton smoke insufflation. The animals were resuscitated according to the Parkland formula with Ringer's lactate in the following 72 h period. Hemodynamic, oxygenation, fluid balance, and plasma ANP levels were serially determined. The effects of smoke inhalation manifested as deteriorated oxygenation, and increased fluid accumulation after a sustained initial shock period of more than 12 h. Plasma ANP levels in the burn+smoke group showed a biphasic elevation, whereas the burn group showed no appreciable changes throughout the whole experimental period. The initial increase in plasma ANP concentrations occurred immediately after injury (from 96+/-10 at baseline to 136+/-17 pg/mL at 3h after injury); thereafter, it decreased towards baseline value, followed by a second increase in the post resuscitation period (183+/-43 pg/mL at 72 h after injury). Decreased urine output and accentuated pulmonary vascular resistance in the combined injury group was observed between the two ANP level peaks, indicating that ANP release modified physiological responses to the burn+smoke injury.

Topics: Animals; Atrial Natriuretic Factor; Burns; Disease Models, Animal; Female; Fluid Therapy; Hematocrit; Hemodynamics; Oxygen Consumption; Sheep; Smoke Inhalation Injury; Vascular Resistance; Water-Electrolyte Balance

Atrial natriuretic peptide (ANP) plays a part in the regulation of volume homeostasis and possibly, in the pathophysiology of water and electrolyte disorder. Patients with serious burn injuries risk huge body fluids losses, which are compensated for by perfusion. Blood volume and the renin and aldosterone system are also disturbed. This study measured plasma ANP and vasoactive intestinal polypeptide (VIP) in patients with >20% total burned surface area (TBSA), at admission and 24 h post-admission.Eleven patients (mean age 46.5 years, 8 males) with a mean TBSA of 34.5% were sampled. Standard treatment was given. Eleven closely age-matched volunteers were used as controls. A specific ELISA method suitable for the measurement of ANP and VIP was used.ANP was higher (p<0.0001), while VIP was lower (p=NS) in patients' samples compared to controls. While the level of VIP was higher at 24 h post-admission, mean ANP level remained about the same. The increased levels of plasma ANP may result from volaemic disturbances during resuscitation, low VIP levels, the increase in pulmonary resistance or post-burn stress.

Topics: Adult; Aged; Atrial Natriuretic Factor; Blood Volume; Body Surface Area; Burns; Case-Control Studies; Dehydration; Enzyme-Linked Immunosorbent Assay; Female; Fluid Therapy; Follow-Up Studies; Homeostasis; Humans; Lung; Male; Middle Aged; Patient Admission; Regional Blood Flow; Renin-Angiotensin System; Resuscitation; Skin; Statistics, Nonparametric; Vascular Resistance; Vasoactive Intestinal Peptide; Water-Electrolyte Imbalance

Data characterizing the endocrine stress response to burn injury in children are sparse. We have measured the levels of the stress hormones arginine vasopressin, catecholamines-adrenaline, noradrenaline and dopamine-atrial natriuretic peptide and hormones of the renin-angiotensin-aldosterone system in admission blood samples taken from 35 children admitted to the burns unit of the regional children's hospital. Hormone levels were compared with the size of burn injury. With the exception of adrenaline, there were significant positive correlations between vasopressin (r = 0.707, p < 0.0001), plasma renin activity (r = 0.721, P < 0.0001), angiotensin II (r = 0.512, P = 0.002), aldosterone (r = 0.620, P < 0.0001), noradrenaline (r = 0.430, P = 0.0189), dopamine (r = 0.627, P = 0.0024) and percentage burn surface area, and a negative correlation between atrial natriuretic peptide (r = 0.548, P = 0.0008) and burn surface area. It is concluded that the hormones which react to stress are very sensitive to burn injury in children, and that the magnitude of their response is closely related to the size of the burn surface area.

Topics: Arginine Vasopressin; Atrial Natriuretic Factor; Burns; Catecholamines; Child; Child, Preschool; Chromatography, High Pressure Liquid; Humans; Infant; Radioimmunoassay; Renin-Angiotensin System; Severity of Illness Index; Stress, Physiological

Plasma renin activity (PRA), angiotensin II (AII), atrial natriuretic peptide (ANP) and AII/ANP were determined by radioimmunoassay in samples of blood from 59 burn patients. The results demonstrated that PRA, AII, ANP, AII/ANP increased significantly postburn. The increased level of AII/ANP correlated positively with the extent of burn injury as well as the severity of postburn renal dysfunction suggesting that the imbalance of AII and ANP played an important role in the pathogenesis of postburn renal damage.

Topics: Acute Kidney Injury; Adolescent; Adult; Angiotensin II; Atrial Natriuretic Factor; Burns; Female; Glomerular Filtration Rate; Humans; Male; Radioimmunoassay; Renin

To clarify how plasma atrial natriuretic peptide concentrations vary with the severity of acute lung injury. The influence of coexisting diseases which trigger acute lung injury was also examined.. Prospective study.. Intensive care unit of a university hospital.. Fifty patients who had standard risk factors for acute lung injury including sepsis syndrome, major surgery, prolonged hypotension, aspiration of gastric contents, and burns. Twenty-five of these patients had acute lung injury (group 3) caused by these disorders; the remaining 25 patients had risk factors only (group 2). Ten age-matched normal volunteers were selected as controls (group 1).. None.. Plasma atrial natriuretic peptide concentration was measured in these patients and compared with the severity of acute lung injury. In group 3, a significant increase in the mean plasma atrial natriuretic peptide concentration was observed (188 +/- 78 pg/mL, p < .01) compared with group 2 (54 +/- 28 pg/mL) and the age-matched control group (30 +/- 8 pg/mL). This increase was related to the onset of acute lung injury and returned to control concentrations after recovery. Plasma atrial natriuretic peptide concentrations in group 3 correlated highly with a lung injury score representing the severity of acute lung injury (r2 = .45, p < .01), but did not correlate with other cardiopulmonary variables.. The results suggest that severity of lung injury, but not other predisposing disorders, may be the key factor leading to the increase in plasma atrial natriuretic peptide concentrations observed in these patients.

Topics: Analysis of Variance; Atrial Natriuretic Factor; Burns; Comorbidity; Hemorrhage; Humans; Hypotension; Japan; Linear Models; Pneumonia, Aspiration; Prospective Studies; Respiratory Distress Syndrome; Risk Factors; Systemic Inflammatory Response Syndrome

The purpose of this experiment is to investigate the changes in plasma concentration cardionatrin of and morphological changes in atrial cardiocytes in rats after severe burn by means of radioimmunoassay, immunocytochemistry, electron microscopy and morphometry. The results showed that: (1) At 1, 2 h postburn the plasma cardionatrin concentrations were significantly increased, at 6-48 h significantly decreased and at 72, 168 h returned to normal. (2) The changes in plasma cardionatrin concentration were related to the alterations of secretory function in atrial cardiocytes. (3) The pathological changes in atrial cardiocytes were characterized by appearing early. The pathological changes and alterations of secretory function of atrial cardiocytes ran a dynamic course, which could be roughly divided into three phases, the phase of stress, the phase of secretory inhibition and injury, and the phase of recovery. (4) It might be one of the forms of atrial cardiocytes secreting cardionatrin that the atrial specific granules with intact limiting membrane were excreted from the defect of plasmalemma.

Topics: Animals; Atrial Natriuretic Factor; Burns; Heart Atria; Male; Microscopy, Electron; Myocardium; Rats; Rats, Wistar

The relationship between effective blood volume and related hormones in burn patients following resuscitation is not well understood. Previous reports have suggested that hormone secretion is altered by a resetting of neural control mechanisms. Serum and urine sodium, plasma renin activity, serum ADH, cardiac index, effective renal plasma flow, and total blood volume were measured in seven burn patients (mean age, total burn size, and postburn day: 32 years, 56%, and 9 days, respectively). The same values (with the exception of cardiac index and blood volume) were measured in 10 control patients (mean age, 24 years). The blood volume of patients was measured by 51chromium red blood cell (RBC) labeling and compared to normal predicted values based on body surface area and sex. Mean serum sodium and osmolality were 138 mmol/L (millimolar) and 286 mosm/kg, respectively, in both patients and control subjects. Mean +/- standard error of the mean total blood volume in the patients was low, 81% +/- 4% of predicted values. Cardiac index and renal plasma flow were significantly elevated. Plasma renin activity and antidiuretic hormone (ADH) levels were elevated and altered in the direction expected from blood volume measurements despite the findings of increased blood flow. Dissociation of organ flow and hormonal response suggests that simultaneous direct blood volume measurements are necessary to elucidate factors other than altered neural control settings to explain hormonal changes in the flow phase of injury. Depressed total blood volume appears to promote elevated ADH levels in burn patients following resuscitation. Whether there is an additional role of altered neural control settings remains to be established.

Topics: Adrenocorticotropic Hormone; Adult; Aldosterone; Atrial Natriuretic Factor; Blood Volume; Burns; Erythrocyte Volume; Female; Hemodynamics; Humans; Hydrocortisone; Male; Osmolar Concentration; Plasma Volume; Potassium; Renin; Sodium; Vasopressins; Water-Electrolyte Balance

To define the relationship between atrial natriuretic polypeptide and the physiological changes of water and electrolytes after burns, the changes in plasma hormonal levels, including atrial natriuretic polypeptide, and urinary water and sodium excretions were examined in burned rats. Further, to elucidate the physiological significance of atrial natriuretic polypeptide after burns, the effects of a specific antiserum against atrial natriuretic polypeptide were determined in burned rats. Plasma atrial natriuretic polypeptide levels in rats following 30 per cent BSA full skin thickness burns were elevated for sustained periods (432.3 +/- 156.5 pg/ml, P less than 0.01 on day 1 postburn, 244.5 +/- 73.7 pg/ml, P less than 0.05 on day 3 postburn). Urine volume and sodium excretion decreased significantly during the first 72 h after burns. On day 3 postburn, urine volume and sodium excretion began to increase significantly. Specific rabbit antiserum against atrial natriuretic polypeptide was injected into the burned rats during this diuretic phase. Significant inhibition of diuresis and natriuresis was observed after the injection of antiserum (27.5 +/- 2.4 per cen decrease in urine volume, 57.1 +/- 10.4 per cent decrease in sodium excretion). These results suggest that atrial natriuretic polypeptide plays a physiological role in the regulation of urinary water and sodium excretion after burns.

Topics: Aldosterone; Animals; Arginine Vasopressin; Atrial Natriuretic Factor; Body Weight; Burns; Diuresis; Epinephrine; Male; Natriuresis; Norepinephrine; Peptide Fragments; Radioimmunoassay; Rats; Rats, Inbred Strains; Sodium; Time Factors

Hypovolemia, low cardiac output, and systemic vasoconstriction are major etiologic factors in acute renal failure occurring in the early postburn period, and elevated levels of stress-related hormones (catecholamines, angiotensin, aldosterone, and vasopressin) are implicated in the mechanism. By counteracting the effects of the hormones, atrial natriuretic polypeptide (ANP) regulates the renal response to burns. ANP was elevated after burns, protecting the kidneys by increasing renal blood flow and urine output. In pulmonary acid injury, increased ANP levels were associated with natriuresis which was reduced by administration of anti-ANP serum. Exogenous ANP given to dogs under constant norepinephrine infusion resulted in improvement of hemodynamic and renal parameters. To prevent tubular damage due to hemoglobinuria, a haptoglobin preparation is administered to patients with extensive third-degree burns. With sufficient fluid replacement, these new treatments will reduce the incidence of acute renal failure in the early postburn period.

Topics: Acute Kidney Injury; Animals; Atrial Natriuretic Factor; Burns; Dogs; Haptoglobins; Hemodynamics; Hemoglobinuria; Humans; Models, Biological; Rats; Resuscitation

Fourteen adult patients (mean age, 35 yrs) with 20-60% total body surface area (TBSA) burns (mean, 35%) were resuscitated using hypertonic sodium lactate (HSL: sodium = 250 mEq/L). Plasma concentrations of atrial natriuretic peptide (ANP), arginine vasopressin (AVP), angiotensin II (A-II), epinephrine (E) and norepinephrine (NE) were measured on admission and for 7 days following burn injury. Serum sodium concentrations and osmolalities were lowest on admission, and were persistently elevated following HSL resuscitation. Plasma AVP levels were highest on admission and correlated with the size of the burn injury. Between days 4 and 5 plasma ANP levels rose while plasma AVP levels returned to normal. Plasma concentrations of AVP and ANP did not correlate with serum osmolality or serum sodium concentrations on admission or after HSL resuscitation. Plasma levels of A-II, NE and E were elevated throughout the 7-day period and were unrelated to the size of the burn.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin II; Arginine Vasopressin; Atrial Natriuretic Factor; Burns; Epinephrine; Female; Fluid Therapy; Humans; Male; Middle Aged; Norepinephrine; Saline Solution, Hypertonic; Water-Electrolyte Balance

Topics: Animals; Atrial Natriuretic Factor; Burns; Dogs; Female; Male; Myocardium; Resuscitation; Shock, Traumatic; Sodium

Topics: Acute Disease; Atrial Natriuretic Factor; Burns; Female; Humans; Male; Middle Aged