natriuretic-peptide--brain and Multiple-Organ-Failure

Cardiogenic shock is difficult to diagnose due to diverse presentations, overlap with other shock states (i.e. sepsis), poorly understood pathophysiology, complex and multifactorial causes, and varied hemodynamic parameters. Despite advances in interventions, mortality in patients with cardiogenic shock remains high. Emergency clinicians must be ready to recognize and start appropriate therapy for cardiogenic shock early.. This review will discuss the clinical evaluation and diagnosis of cardiogenic shock in the emergency department with a focus on the emergency clinician.. The most common cause of cardiogenic shock is a myocardial infarction, though many causes exist. It is classically diagnosed by invasive hemodynamic measures, but the diagnosis can be made in the emergency department by clinical evaluation, diagnostic studies, and ultrasound. Early recognition and stabilization improve morbidity and mortality. This review will focus on identification of cardiogenic shock through clinical examination, laboratory studies, and point-of-care ultrasound.. The emergency clinician should use the clinical examination, laboratory studies, electrocardiogram, and point-of-care ultrasound to aid in the identification of cardiogenic shock. Cardiogenic shock has the potential for significant morbidity and mortality if not recognized early.

Topics: Acidosis, Lactic; Bradycardia; Confusion; Early Diagnosis; Echocardiography; Edema; Electrocardiography; Emergency Service, Hospital; Heart Failure; Heart Murmurs; Humans; Hypotension; Kidney Function Tests; Lactic Acid; Liver Function Tests; Multiple Organ Failure; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Physical Examination; Point-of-Care Systems; Pulmonary Edema; Shock, Cardiogenic; Tachycardia; Troponin

Key links in the chain of survival for the management of severe sepsis and septic shock are early identification and comprehensive resuscitation of high-risk patients. Multiple studies have shown that the first 6 hours of early sepsis management are especially important from a diagnostic, pathogenic, and therapeutic perspective, and that steps taken during this period can have a significant impact on outcome. The recognition of this critical time period and the robust outcome benefit realized in previous studies provides the rationale for adopting early resuscitation as a distinct intervention. Sepsis joins trauma, stroke, and acute myocardial infarction in having "golden hours," representing a critical opportunity early on in the course of disease for actions that offer the most benefit.

Topics: Calcitonin; Critical Care; Hemodynamics; Humans; Lactic Acid; Multiple Organ Failure; Natriuretic Peptide, Brain; Prognosis; Protein Precursors; Resuscitation; Sepsis; Shock, Septic; Survival Rate; Troponin

To report an unusual case of simultaneous presentation of Addison's and Graves' disease in an adolescent female previously diagnosed with type 1 diabetes (T1D) and Hashimoto's.. A 15-year-old female with T1D and hypothyroidism presented to the emergency department with altered mental state, fever, and left arm weakness for one day. Clinical work-up revealed coexistent new-onset adrenal insufficiency and hyperthyroidism. Her clinical course was complicated by severe, life-threating multisystem organ dysfunction including neurologic deficits, acute kidney injury, and fluid overload. Thyroidectomy was ultimately performed in the setting of persistent signs of adrenal crises and resulted in rapid clinical improvement.. Endocrinopathy should be included in the differential diagnosis of altered mental status. This case additionally illustrates the challenges of managing adrenal insufficiency in the setting of hyperthyroidism and supports the use of thyroidectomy in this situation.

Topics: Addison Disease; Adolescent; Adrenal Insufficiency; Diabetes Mellitus, Type 1; Female; Graves Disease; Humans; Multiple Organ Failure; Natriuretic Peptide, Brain; Peptide Fragments; Thyroidectomy

Topics: Betacoronavirus; C-Reactive Protein; Coronavirus Infections; COVID-19; Cytokine Release Syndrome; Endothelium, Vascular; Humans; Interleukin-1; Macrophage Activation; Multiple Organ Failure; Myocardial Ischemia; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; SARS-CoV-2; Troponin I

The purpose of this study was to investigate the value of N-terminal pro brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and procalcitonin (PCT) in predicting mortality in septic patients during hospitalization with mortality risk<10% evaluated by Sepsis-related Organ Failure Assessment (SOFA).. Prospective, observational study performed in sepsis patients with SOFA risk<10%. We obtained levels of biomarkers in the first 72h after admission in hospital. All patients were monitored during hospitalization or until death. We used ROC curves to determine area under curve (AUC) and identify the best cutoff concentrations to predict mortality.. A total of 174 patients were analyzed. Seventeen (9.8%) patients died during hospitalization. The AUC of NT-proBNP was 0.793 (95% CI 0.686-0.9; P<.0005) compared to AUC of CRP (0.728; 95% CI 0.617-0.839; P=.004) and AUC of PCT (0.684; 95% CI 0.557-0.811; P=.019). Factors independently associated with in-hospital mortality were NT-proBNP>1,330pg/ml (OR=23.23; 95% CI 2.92-182.25; P=.003) and to have predisposing factors (OR=3.05; 95% CI 1.3-9.3; P=.044) CONCLUSIONS: In patients with low mortality risk according to SOFA score, NT-proBNP obtained in the first 72h after admission prove to be a powerful predictor of mortality. Their implementations in clinical practice would improve the predictive ability of clinical severity scores.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Female; Hospital Mortality; Humans; Male; Middle Aged; Multiple Organ Failure; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Peptide Fragments; Prognosis; Prospective Studies; Risk Factors; ROC Curve; Sepsis

In patients with severe burns, resuscitation with large volumes of fluid is needed, partly because of an increase in capillary leakage. Corticosteroids might be beneficial by diminishing capillary leakage. This study aimed to assess in severely burned nonseptic patients whether hydrocortisone (HC) improved outcome and diminished capillary leakage.. Retrospective analyses of a prospectively collected database were performed, including 39 patients (age 52 [35-62] years, 72% male). Patients were divided based on HC therapy. First, in patients in whom HC was started late, that is when deteriorating (late; 5-12 days postburn) data before and after start of HC were compared. Second, patients in whom HC was started day 0 or 1 postburn (upfront; within 48 hours) were compared with patients who did not receive HC (control). Outcome was assessed as organ dysfunction by Denver Multiple Organ Failure (MOF) score and Sequential Organ Failure Assessment (SOFA) score. As markers for capillary leakage and hydration state, proteinuria, B-type natriuretic peptide (BNP), and fluid administration were assessed. Follow-up was 20 days postburn. Possible adverse effects including mortality were recorded. Repeated measurement regression analyses were performed using MLwiN.. In the late group, Denver MOF and SOFA scores significantly decreased after HC (P<.001). Proteinuria tended to decrease (P=.13), BNP increased on the days HC was used (P<.001), and amounts of fluids diminished (P<.001). In the upfront vs control group, Denver MOF and SOFA scores (P<.001) decreased more quickly. Proteinuria (P=.006) and administered fluids decreased more rapidly (P<.001). Mortality rate, numbers of positive blood cultures, incidence of pneumonia, and graft loss were similar in all groups.. Hydrocortisone treatment in severe burned patients without sepsis might improve organ dysfunction possibly because of a reduction in capillary leakage, as reflected by a decrease of proteinuria, an increase of BNP, and diminished fluid resuscitation volumes.

Topics: Adult; Anti-Inflammatory Agents; Bacteremia; Biomarkers; Blood Culture; Burns; Capillary Permeability; Case-Control Studies; Databases, Factual; Female; Fluid Therapy; Follow-Up Studies; Humans; Hydrocortisone; Male; Middle Aged; Multiple Organ Failure; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Pneumonia; Proteinuria; Resuscitation; Retrospective Studies

Topics: Biomarkers; Critical Illness; Diagnosis, Differential; Heart Failure; Humans; Multiple Organ Failure; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Severity of Illness Index

The aim of the study was to evaluate the relationship between N-terminal brain natriuretic propeptide (NT-proBNP) plasma concentrations and the severity of organ dysfunction assessed by the Sepsis-related Organ Failure Assessment (SOFA) score in septic patients. NT-proBNP, SOFA score, and survival were evaluated in 20 consecutive septic patients. They were prospectively included in the study when the sepsis criteria according to the ACCP/SCCM definitions (modified by the Polish Working Group for Sepsis) were fulfilled. Blood serum NT-proBNP concentrations were determined in each patient at given time intervals and the severity of organ dysfunction was estimated according to the SOFA score. The first measurement was performed within 12 h after the patient's inclusion into the study, the second, third, and fourth at 12, 24, and 48 hours after the first, and then every 48 hours thereafter. The mean NT-proBNP concentration and the mean SOFA score were 140.80+/-84.65 pg/ml and 6.31+/-3.75 points, respectively. The correlation coefficient between NT-proBNP level and SOFA score was R=0.5164 (p<0.05). The mortality in the studied group was 30%.. NT-proBNP levels correlate with the severity of organ dysfunction as assessed by the SOFA score in septic patients.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Multiple Organ Failure; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sepsis; Survival Rate