natriuretic-peptide--brain and Sepsis

The aim of this study was to evaluate the diagnostic performance of all biomarkers studied to date for the early diagnosis of sepsis in hospitalized patients with burns.. Early clinical diagnosis of sepsis in burns patients is notoriously difficult due to the hypermetabolic nature of thermal injury. A considerable variety of biomarkers have been proposed as potentially useful adjuncts to assist with making a timely and accurate diagnosis.. We searched Medline, Embase, Cochrane CENTRAL, Biosis Previews, Web of Science, and Medline In-Process to February 2020. We included diagnostic studies involving burns patients that assessed biomarkers against a reference sepsis definition of positive blood cultures or a combination of microbiologically proven infection with systemic inflammation and/or organ dysfunction. Pooled measures of diagnostic accuracy were derived for each biomarker using bivariate random-effects meta-analysis.. We included 28 studies evaluating 57 different biomarkers and incorporating 1517 participants. Procalcitonin was moderately sensitive (73%) and specific (75%) for sepsis in patients with burns. C-reactive protein was highly sensitive (86%) but poorly specific (54%). White blood cell count had poor sensitivity (47%) and moderate specificity (65%). All other biomarkers had insufficient studies to include in a meta-analysis, however brain natriuretic peptide, stroke volume index, tumor necrosis factor (TNF)-alpha, and cell-free DNA (on day 14 post-injury) showed the most promise in single studies. There was moderate to significant heterogeneity reflecting different study populations, sepsis definitions and test thresholds.. The most widely studied biomarkers are poorly predictive for sepsis in burns patients. Brain natriuretic peptide, stroke volume index, TNF-alpha, and cell-free DNA showed promise in single studies and should be further evaluated. A standardized approach to the evaluation of diagnostic markers (including time of sampling, cut-offs, and outcomes) would be useful.

Topics: Biomarkers; Burns; Cell-Free Nucleic Acids; Early Diagnosis; Humans; Natriuretic Peptide, Brain; Sensitivity and Specificity; Sepsis

Can laboratory tests that are routinely used in adult patients also be used in pediatric patients? Does the current literature support the routine use of troponin, brain natriuretic peptide, D-dimer, and lactate in children? Adult problems such as acute coronary syndrome and pulmonary embolism are rare in pediatrics, and there is a paucity of literature on how blood tests commonly used to help diagnose these conditions in adults play a role in the diagnosis and management of children. This article presents the literature about 4 common blood tests and examines the clinical applications of each.

Topics: Asthma; Biomarkers; Child; Fibrin Fibrinogen Degradation Products; Heart Diseases; Humans; Infections; Intussusception; Lactic Acid; Mitochondrial Diseases; Mucocutaneous Lymph Node Syndrome; Natriuretic Peptide, Brain; Prognosis; Pulmonary Embolism; Respiratory Distress Syndrome; Sepsis; Troponin; Wounds and Injuries

Sepsis continues to be a leading public health burden in the United States and worldwide. With the increasing use of advanced laboratory technology, there is a renewed interest in the use of biomarkers in sepsis to aid in more precise and targeted decision-making. Natriuretic peptides have been increasingly recognized to play a role outside of heart failure. They are commonly elevated among critically ill patients in the setting of cardiopulmonary dysfunction and may play a role in identifying patients with sepsis and septic shock. There are limited data on the role of these biomarkers in the diagnosis, management, outcomes and prognosis of septic patients. This review seeks to describe the role of natriuretic peptides in fluid resuscitation, diagnosis of ventricular dysfunction and outcomes and the prognosis of patients with sepsis. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have been noted to be associated with left ventricular systolic and diastolic and right ventricular dysfunction in patients with septic cardiomyopathy. BNP/NT-proBNP may predict fluid responsiveness, and trends of these peptides may play a role in fluid resuscitation. Despite suggestions of a correlation with mortality, the role of BNP in mortality outcomes and prognosis during sepsis needs further evaluation.. A sepse persiste como importante sobrecarga à saúde pública nos Estados Unidos e em todo o mundo. Com o crescente uso de tecnologias laboratoriais, tem se renovado o interesse na utilização de biomarcadores na sepse, para auxiliar em um processo mais preciso e direcionado para tomadas de decisão. Os peptídeos natriuréticos vem sendo cada vez mais reconhecidos por seu papel que vai além da insuficiência cardíaca. Estes peptídeos estão comumente elevados em pacientes críticos que apresentam condições de disfunção cardiopulmonar e podem ter papel na identificação de pacientes com sepse e choque séptico. São poucos os dados disponíveis em relação ao papel destes biomarcadores no diagnóstico, no controle, nos desfechos e no prognóstico de pacientes sépticos. Esta revisão procura descrever o papel dos peptídeos natriuréticos na ressuscitação volêmica, no diagnóstico de disfunção ventricular, nos desfechos e no prognóstico de pacientes com sepse. Tem sido observado que o peptídeo natriurético tipo B (BNP) e o fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP) se associam com disfunção ventricular sistólica e diastólica, tanto esquerda quanto direita, em pacientes com cardiomiopatia séptica. O BNP e o NT-proBNP podem predizer a responsividade a volume, e as tendências de medidas seriadas destes peptídeos podem ser importantes na ressuscitação volêmica. A despeito da sugestão de correlação com mortalidade, o papel do BNP nos desfechos de mortalidade e prognóstico, durante a sepse, ainda necessita melhor avaliação.

Topics: Fluid Therapy; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis; Shock, Septic; Treatment Outcome; Ventricular Dysfunction, Left

Sepsis is a common disease in critical patients, which may lead to myocardial damage, thereby aggravating the severity of the patients' condition, and causing adverse prognosis. How to detect sepsis with myocardial injury as early as possible, and use corresponding treatment measures on time are essential. Cardiac troponin I (cTnI), brain natriuretic peptide (BNP), myoglobin (Mb), MB isoenzyme of creatine kinase (CK-MB) and other traditional cardiac markers are easily affected by the complications of other critical diseases, thus the diagnostic value of those markers for myocardial injury of sepsis is reduced. In recent years, there have been some studies on heart-type fatty acid binding protein (H-FABP), microRNA (miRNA), soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), high mobility group protein B1 (HMGB1), neutrophil gelatinase-associated lipocalin (NGAL), histone and other new biomarkers of myocardial injury in septic patients. This article reviewed the value of these unconventional cardiac markers in the diagnosis of sepsis-induced myocardial injury, with the hope to provide some help for clinic.

Topics: Biomarkers; Creatine Kinase, MB Form; Humans; Myocardial Infarction; Myoglobin; Natriuretic Peptide, Brain; Sepsis; Troponin I

The aim of this meta-analysis was to clarify the diagnostic role of plasma BNP and NT-proBNP in predicting mortality for septic patients.. A systematic review was conducted prior to January 2018. Summary sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) of the prognostic value of plasma BNP and NT-proBNP for septic patients. The area under the receiver operating curves (AUROC) were used to summarize overall test performance.. Twenty-two studies with 3417 septic patients were selected in the analysis. The summary sensitivity, specificity, PLR, NLR, DOR and the AUROC of the overall analysis of BNP were: 0.84, 0.73, 3.1, 0.22, 14, 0.85; and these values of NT-proBNP were: 0.71, 0.73, 2.6, 0.39, 7 and 0.7 respectively; Subgroup analysis and meta-regression analyses showed that the tested method and observation endpoint influenced the summary sensitivity, specificity of BNP, but the tested day, tested method or observation endpoint did not influence the summary sensitivity, specificity of NT-proBNP.. This meta-analysis indicates that both elevated plasma BNP and NT-proBNP have moderate predicts value for the mortality of septic patients, and the tested method and observation endpoint influence the results of BNP.

Topics: Area Under Curve; Biomarkers; China; Humans; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Prognosis; Sensitivity and Specificity; Sepsis

Sepsis-induced myocardial dysfunction is a common complication in septic patients and is associated with increased mortality. In the clinical setting, it was once believed that myocardial dysfunction was not a major pathological process in the septic patients, at least in part, due to the unavailability of suitable clinical markers to assess intrinsic myocardial function during sepsis. Although sepsis-induced myocardial dysfunction has been studied in clinical and basic research for more than 30 years, its pathophysiology is not completely understood, and no specific therapies for this disorder exist. The purpose of this review is to summarize our current knowledge of sepsis-induced myocardial dysfunction with a special focus on pathogenesis and clinical characteristics.

Topics: Biomarkers; Blood Pressure; Calcium; Cardiomyopathies; Electrocardiography; Heart; Humans; Natriuretic Peptide, Brain; Sepsis

Anesthesiologists faced with a patient with sepsis and concurrent cardiac dysfunction must be cognizant of the patient's cardiac status and cause of the cardiac problem to appropriately adapt physiologic and metabolic monitoring and anesthetic management. Anesthesia in such patients is challenging because the interaction of sepsis and cardiac dysfunction greatly complicates management. Intraoperative anesthesia management requires careful induction and maintenance of anesthesia; optimizing intravascular volume status; avoiding lung injury during mechanical ventilation; and close monitoring of arterial blood gases, serum lactate concentrations, and hematology renal and electrolyte parameters. Such patients have increased mortality because of their inability to adequately compensate for the cardiovascular changes caused by sepsis.

Topics: Anesthesia; Blood Glucose; Etomidate; Extracorporeal Membrane Oxygenation; Heart Diseases; Humans; Natriuretic Peptide, Brain; Sepsis

Topics: Biomarkers; Child; Child, Preschool; Critical Illness; Early Diagnosis; Heart Failure; Humans; Infant; Intensive Care Units; Mucocutaneous Lymph Node Syndrome; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Pulmonary Heart Disease; Risk Assessment; Sepsis; Ventricular Dysfunction, Left

Acute kidney injury (AKI) remains a challenge in terms of diagnosis and classification, its morbidity and mortality remaining high in the face of improving clinical protocols. Current clinical criteria use serum creatinine (sCr) and urine output to classify patients. Ongoing research has identified novel biomarkers that may improve the speed and accuracy of patient evaluation and prognostication, yet the route from basic science to clinical practice remains poorly paved. International evidence supporting the use of plasma neutrophil gelatinase-associated lipocalin (NGAL) as a valuable biomarker of AKI and chronic kidney disease (CKD) for a number of clinical scenarios was presented at the 31st International Vicenza Course on Critical Care Nephrology, and these data are detailed in this review. NGAL was shown to be highly useful alongside sCr, urinary output, and other biomarkers in assessing kidney injury; in patient stratification and continuous renal replacement therapy (CRRT) selection in paediatric AKI; in assessing kidney injury in conjunction with sCr in sepsis; in guiding resuscitation protocols in conjunction with brain natriuretic peptide in burn patients; as an early biomarker of delayed graft function and calcineurin inhibitor nephrotoxicity in kidney transplantation from extended criteria donors; as a biomarker of cardiovascular disease and heart failure, and in guiding CRRT selection in the intensive care unit and emergency department. While some applications require further clarification by way of larger randomised controlled trials, NGAL nevertheless demonstrates promise as an independent biological marker with the potential to improve earlier diagnosis and better assessment of risk groups in AKI and CKD. This is a critical element in formulating quick and accurate decisions for individual patients, both in acute scenarios and in long-term care, in order to improve patient prognostics and outcomes.

Topics: Acute Kidney Injury; Acute-Phase Proteins; Age Factors; Biomarkers; Burns; Cardiopulmonary Bypass; Cardiovascular Diseases; Clinical Trials as Topic; Critical Illness; Graft Survival; Humans; Intensive Care Units; Lipocalin-2; Lipocalins; Natriuretic Peptide, Brain; Proto-Oncogene Proteins; Renal Replacement Therapy; Resuscitation; Sepsis; Treatment Outcome

Sepsis is a severe complication of critically ill patients that is characterized by the systemic inflammatory response syndrome (SIRS). The increased levels of B-type natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are related with dysfunction of the cardiovascular system and systemic inflammation. In recent years, BNP and NT-proBNP have been the focus of studies evaluating the severity and prognosis of sepsis. In this study, we will review the role of BNP and NT-proBNP in sepsis.

Topics: Humans; Natriuretic Peptide, Brain; Protein Precursors; Sepsis

The endocrine heart produces the polypeptide hormones Atrial Natriuretic Factor (ANF or ANP) and Brain Natriuretic Peptide (BNP). Through the peripheral actions of these hormones the heart contributes to the regulation of the cardiac preload and afterload. More recently, new functions for these hormones have been described including the modulation of the immune response. Plasma levels of BNP but not those of ANF, increase following an acute rejection episode of a cardiac allotransplant but return to levels pre-rejection with successful treatment. This observation constitutes the first observation leading to characterizing the interactions of BNP with the immune response. Several other pathologies with an inflammatory component are now known to be associated with an increase in the production of BNP. Such an increase is due to an increase in the transcriptional activity of the BNP gene induced by cytokines and related substances. In vitro investigations have shown that an increase in BNP directly modulates immunological activity. Inflammation and hemodynamic changes co-exist in several cardiovascular diseases and therefore it may be beneficial to measure circulating levels of both ANF and BNP as biomarkers of changes in intravascular volume and of changes in intravascular volume plus inflammation, respectively. Changes in plasma ANF, that are relatively larger than those of BNP, might be an indication of hemodynamic deterioration while important changes in circulating BNP could indicate a worsening of the inflammatory process.

Topics: Animals; Atrial Natriuretic Factor; Biomedical Research; Hemodynamics; Humans; Inflammation; Myocarditis; Myocytes, Cardiac; Natriuretic Peptide, Brain; Sepsis

Early identification of septic patients at high risk of dying remains a challenge. The prognostic role of brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) in septic patients remains controversial. The purpose of this systematic review and meta-analysis was to investigate the value of elevated BNP or NT-proBNP in predicting mortality in septic patients.. PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched (up to February 18, 2011). Studies were included if they had prospectively collected data on all-cause mortality in adult septic patients with either plasma BNP or NT-proBNP measurement. Studies that failed to construct a 2 × 2 table of results were excluded. Two authors independently determined the validity of included studies and extracted data.. 12 studies with a total of 1,865 patients were included. Elevated natriuretic peptides were significantly associated with increased risk of mortality (odds ratio (OR) 8.65, 95% confidence interval (CI) 4.94 to 15.13, P < 0.00001). The association was consistent for BNP (OR 10.44, 95% CI 4.99 to 21.58, P < 0.00001) and NT-proBNP (OR 6.62, 95% CI 2.68 to 16.34, P < 0.0001). The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 79% (95% CI 75 to 83), 60% (95% CI 57 to 62), 2.27 (95% CI 1.83 to 2.81) and 0.32 (95% CI 0.22 to 0.46), respectively.. Our results suggested that an elevated BNP or NT-proBNP level may prove to be a powerful predictor of mortality in septic patients. Future larger and more adequately powered prospective studies are warranted to clarify the assay standardization, the optimal cut-off, and the prognostic value of BNPs in conjunction with other biomarkers.

Topics: Biomarkers; Clinical Trials as Topic; Humans; Mortality; Natriuretic Peptide, Brain; Predictive Value of Tests; Sepsis

The use of cardiac biomarkers in the intensive care setting is gaining increasing popularity. There are several reasons for this increase: there is now the facility for point-of-care biomarker measurement providing a rapid diagnosis; biomarkers can be used as prognostic tools; biomarkers can be used to guide therapy; and, compared with other methods such as echocardiography, the assays are easier and much more affordable. Two important characteristics of the ideal biomarker are disease specificity and a linear relationship between the serum concentration and disease severity. These characteristics are not present, however, in the majority of biomarkers for cardiac dysfunction currently available. Those clinically useful cardiac biomarkers, which naturally received the most attention, such as troponins and B-type natriuretic peptide, are not as specific as was originally thought. In the intensive care setting, it is important for the user to understand the degree of specificity of these biomarkers and that the interpretation of the results should always be guided by other clinical information. The present review summarizes the available biomarkers for different cardiac conditions. Potential biomarkers under evaluation are also briefly discussed.

Topics: Biomarkers; CA-125 Antigen; Cardiovascular Diseases; CD40 Ligand; Choline; Creatine Kinase, MB Form; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins; Humans; Intensive Care Units; Interleukins; Myocardium; Natriuretic Peptide, Brain; Necrosis; Peroxidase; Point-of-Care Systems; Sepsis; Serum Albumin; Troponin; Urocortins

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

Circulating concentrations of B-type natriuretic peptide (BNP) and the aminoterminal fragment (NT-proBNP) of its prohormone (proBNP) are increased in congestive heart failure in proportion to the severity of symptoms, the degree of left ventricular dysfunction, and cardiac filling pressures. Following the introduction of rapid, automated assays for determination of BNP and NT-proBNP, these peptides are increasingly used for diagnostic and prognostic purposes.. To review studies evaluating the diagnostic and prognostic value of BNP and NT-proBNP, with special emphasis on their performance as indicators of acute heart failure in the intensive care unit.. In patients presenting with acute dyspnea, both BNP and NT-proBNP are accurate indicators of acute heart failure and provide prognostic information above and beyond conventional risk markers. Increased plasma levels of BNP and NT-proBNP are not specific for heart failure and may be influenced by a variety of cardiac and noncardiac conditions commonly seen in the intensive care unit, including myocardial ischemia, cardiac arrhythmias, sepsis, shock, anemia, renal failure, hypoxia, acute pulmonary embolism, pulmonary hypertension, and acute respiratory distress syndrome.. The diagnostic performance of BNP and NT-proBNP as indicators of acute heart failure depends on the clinical setting. In the intensive care unit, particular caution should be used in the interpretation of elevated BNP and NT-proBNP levels.

Topics: Acute Disease; Biomarkers; Dyspnea; Heart Failure; Humans; Intensive Care Units; Lung Diseases; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis

Timely diagnosis of the different severities of septic inflammation is potentially lifesaving because therapies that have been shown to lower mortality should be initiated early. Sepsis and severe sepsis are accompanied by clinical and laboratory signs of systemic inflammation but patients with inflammation caused by noninfectious causes may present with similar signs and symptoms. It is important to identify markers for an early diagnosis of sepsis and organ dysfunction. This article presents currently interesting sepsis biomarkers. Other novel markers and their potential role are discussed.

Topics: Acute-Phase Proteins; Adrenomedullin; Animals; Atrial Natriuretic Factor; Biomarkers; C-Reactive Protein; Calcitonin; Carrier Proteins; Complement C3a; Cytokines; Endotoxins; HLA-DR Antigens; Humans; Membrane Glycoproteins; Natriuretic Peptide, Brain; Neoplasm Proteins; Neopterin; Peptides; Protein C; Protein Precursors; Proteoglycans; Receptors, Immunologic; Sensitivity and Specificity; Sepsis; Triggering Receptor Expressed on Myeloid Cells-1

Biochemical markers are available to detect cardiac involvement in many pediatric disease states and should be considered.. Analyses of three markers are readily available in clinical laboratories for improved diagnosis.. Increased workload of the heart has been associated with the release of biochemical markers (natriuretic peptides and cardiac enzymes) that indicate that a new genetic program has been activated and maladaptation is occurring in the atria, ventricles, or both. This review summarizes those that have been identified in fetal and pediatric practice. The expression of such markers is traced from early embryonic development to fetal life, to the neonate, to childhood, and then to adult life.

Topics: Adolescent; Adult; Atrial Natriuretic Factor; Biomarkers; Child; Graft Rejection; Heart Diseases; Humans; Infant; Infant, Newborn; Mucocutaneous Lymph Node Syndrome; Natriuretic Peptide, Brain; Renal Insufficiency; Sepsis; Troponin T

Degradation of the endothelial glycocalyx is recognized as a major part of the pathophysiology of sepsis. Previous clinical studies, mostly conducted in intensive care settings, showed associations between glycocalyx shedding and clinical outcomes. We aimed to explore the association of plasma syndecan-1, a marker of glycocalyx degradation, with the subsequent fluid requirements and clinical outcomes of emergency department patients with sepsis.. This was a post hoc analysis of a randomized trial of fluid resuscitation in the emergency department. The study was conducted in the emergency department of an urban 1500-bed tertiary care center. The data of 95 adults who were diagnosed with sepsis-induced hypoperfusion and had undergone baseline syndecan-1 measurement were included. The syndecan-1 levels at baseline (T0) and hour 6 (T6) were studied to characterize their association with clinical outcomes, including subsequent fluid administration, organ failure outcomes and mortality.. The median syndecan-1 levels at T0 and T6 were 207 (IQR 135-438) and 207 (IQR 128-490) ng/ml, respectively. Syndecan-1 levels at T0 were correlated with baseline sequential organ failure assessment (SOFA) score (ρ = 0.35, p < 0.001). Syndecan-1 levels at both T0 and T6 were correlated with subsequent fluid administration over 24 and 72 h and associated with the diagnosis of septic shock, the maximum dose of vasopressors and the need for renal replacement therapy (p < 0.05). Higher syndecan-1 levels at T6 were associated with higher 90-day mortality (p = 0.03).. In the emergency department, syndecan-1 levels were associated with fluid requirements, sepsis severity, organ dysfunction, and mortality.

Topics: Aged; Aged, 80 and over; Biomarkers; Emergency Service, Hospital; Endothelium; Female; Fluid Therapy; Glycocalyx; Hospital Mortality; Humans; Male; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Peptide Fragments; Sepsis; Syndecan-1; Treatment Outcome

To investigate the behavior of pentraxin-3 (PTX3), troponin T (hsTnT), N-terminal pro-B type Natriuretic Peptide (NT-proBNP) in sepsis and their relationships with sepsis severity and oxygen transport/utilization impairment.. Retrospective analysis of PTX3, hsTnT, NT-proBNP levels at day 1, 2, and 7 after admission in the intensive care unit in a subset of the Albumin Italian Outcome Sepsis database.. Forty Italian intensive care units.. Nine hundred fifty-eight septic patients enrolled in the randomized clinical trial comparing albumin replacement plus crystalloids and crystalloids alone.. The patients were divided into sextiles of lactate (marker of severity), ScvO2 (marker of oxygen transport), and fluid balance (marker of therapeutic strategy).. PTX3 and hsTnT were remarkably similar in the two treatment arms, while NT-proBNP was almost double in the albumin treatment group. However, as the distribution of all these biomarkers was similar between control and treatment arms, for the sake of clarity, we analyzed the patients as a single cohort. PTX3 (71.8 [32.9-186.3] ng/mL), hsTnT (50.4 [21.6-133.6] ng/L), and NT-proBNP (4,393 [1,313-13,837] ng/L) were abnormally elevated in 100%, 84.5%, 93.4% of the 953 patients and all decreased from day 1 to day 7. PTX3 monotonically increased with increasing lactate levels. The hsTnT levels were significantly higher when ScvO2 levels were abnormally low (< 70%), suggesting impaired oxygen transport compared with higher ScvO2 levels, suggesting impaired oxygen utilization. NT-proBNP was higher with higher lactate and fluid balance. At ScvO2 levels < 70%, the NT-proBNP was higher than at higher ScvO2 levels. However, even with higher ScvO2, the NT-proBNP was remarkably elevated, suggesting volume expansion. Increased level of NT-proBNP showed the strongest association with 90-day mortality.. The selected biomarkers seem related to different mechanisms during sepsis: PTX3 to sepsis severity, hsTnT to impaired oxygen transport, NT-proBNP to sepsis severity, oxygen transport, and aggressive fluid strategy.

Topics: Adult; Aged; Albumins; C-Reactive Protein; Crystalloid Solutions; Databases, Factual; Female; Humans; Intensive Care Units; Italy; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; Sepsis; Serum Amyloid P-Component; Severity of Illness Index; Troponin T

To investigate the protective effect and possible mechanism of Xuebijing Injection on\ myocardial injury in patients with sepsis, and to evaluate its prognostic implications.. Patients with septic myocardial injury were recruited, and were randomly divided into\ two groups: treatment group and control group. All patients in two groups received conventional cluster\ treatment, the patients in treatment group additional received Xuebijing injection dissolved in\ 0.9% sodium chloride injection, and the patients in control group received the same amount of 0.9%\ sodium chloride injection. At the beginning of treatment and 3, 7 and 10-day after treatment, laboratory indicators of cardiac troponin Ⅰ (cTnI), N-terminal proB-type natriuretic peptide (NT-proBNP)\ and procalcitonin (PCT) were respectively tested in venous blood. The patient's length of stay in\ Intensive Care Unit (ICU) and the mortality in 28 days were recorded.. At 3, 7 and 10-day after treatment, the improvements of cTnI, NT-proBNP and PCT in treatment\ group were better than those in control group, and the differences were statistically significant\ (P < 0.05). The mortality of treatment group in 28 days was not significantly different from that of\ control group (P > 0.05). The ICU length of stay of treatment group was shorter than that of control\ group (P > 0.05).. Xuebijing injection could improve the levels of cTnI, NT-proBNP and PCT in patients\ with septic myocardial injury .and it had a protective effect on myocardial injury.

Topics: Adult; Aged; Calcitonin; Drugs, Chinese Herbal; Female; Heart; Heart Injuries; Humans; Injections; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Sepsis; Treatment Outcome; Young Adult

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.. A multicenter, randomized clinical trial about albumin replacement in severe sepsis or septic shock (the Albumin Italian Outcome Sepsis trial).. Forty ICUs in Italy.. Nine hundred and ninety-five patients with severe sepsis or septic shock.. Randomization to albumin and crystalloid solutions or crystalloid solutions alone.. 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.. 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.

Topics: Adult; Aged; Albumins; Biomarkers; Crystalloid Solutions; Female; Heart; Humans; Intensive Care Units; Isotonic Solutions; Italy; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis; Serum Albumin; Shock, Septic; Troponin

The objective of this study was to evaluate therapeutic effectiveness of blood purification (BP) in severely burned patients with sepsis and to assess the prognostic utilities of early serum levels of procalcitonin (PCT), C reactive protein (CRP), brain natriuretic peptide (BNP). One hundred and ninety-five burn sepsis patients admitted in our hospital during May, 2008-May, 2014 were selected for the study and randomly divided into BP treatment (n = 98) and the control groups (n = 97). All of these patients received conventional therapy, while the BP group underwent additional BP treatment. Therapeutic effectiveness and survival rates of the two groups were compared 28 days after the treatment. The BP group was further divided into survivor and mortality groups, and the early serum levels of PCT, CRP, and BNP were compared retrospectively to analyze their relationship with prognosis. Acute physiology and chronic health evaluation and sequential organ failure assessment scores in the two groups were not significantly different before the treatment (p > 0.05). However, after the treatment, mortality in BP group (19.39 %) was significantly lower (p < 0.05) than that of the controls (27.84 %). Serum levels of PCT and CRP in the survivor and mortality groups were not significantly different (p > 0.05), whereas the serum BNP was significantly lower in the patients who survived than those who died (p < 0.05). The receiver-operating characteristic curve analysis further showed that predictive value of PCT and CRP for the burn sepsis prognosis was low (p > 0.05), however, that of the BNP was good (p < 0.05). The results obtained in this study indicate that BP treatment at an early stage can significantly improve the prognosis of burn sepsis. Furthermore, BNP, an important mediator involved in myocardial infarction and heart failure was found to be positively related with the severity of sepsis suggesting its reliable utility as prognostic indicator of sepsis. Thus, serum BNP monitored during the treatment may assist in adjusting the therapeutic strategies.

Topics: Adult; Aged; Area Under Curve; Burns; C-Reactive Protein; Calcitonin; Female; Hemofiltration; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Retrospective Studies; ROC Curve; Sepsis; Young Adult

To investigate the effects of Xuebijing injection on hemodynamics, cardiac function, and endothelial function in patients with severe sepsis in order to study the therapeutic effect of Xuebijing in the treatment of severe sepsis.. A prospective randomized controlled trial was conducted. Sixty-six severe sepsis patients admitted to the Department of Critical Care Medicine of Guangdong Hospital of Traditional Chinese Medicine from March 2013 to February 2014 were enrolled. The patients were divided into control group (n = 31) and Xuebijing group (n = 35). The patients in both groups were treated according to "2012 international guidelines for management of severe sepsis and septic shock", and the patients in Xuebijing group received Xuebijing injection of 50 mL(added with 100 mL of 0.9% sodium chloride injection) twice a day for 5 days, and those in control group received instead 150 mL of 0.9% sodium chloride injection for 5 days. The heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and dosage of vasoactive drugs before and 1 day and 5 days after treatment were determined for hemodynamics assessment. Blood lactic acid (Lac), central venous oxygen saturation (ScvO2), and difference in arterial-venous blood carbon dioxide pressure (Pv-aCO2) were determined for microcirculation assessment. The left ventricular ejection fraction (LVEF), cardiac output (CO), left ventricular end diastolic diameter (LVEDD), the ratio of blood flow of mitral orifice between rapid filling period and atrial systole period (E/A), and B-type natriuretic peptide (BNP) were determined for cardiac function assessment. Vascular endothelial growth factor (VEGF) and soluble receptor (sFLT-1) were assessed for endothelial function assessment. The relationship among the indexes of the hemodynamics, microcirculation, cardiac function, and endothelial function was analyzed with Pearson related-analysis.. After treatment, HR, MAP, CVP, Lac, ScvO2, and Pv-aCO2 were improved in both groups compared with those before treatment, and the dosage of norepinephrine (NE) was decreased in Xuebijing group. Compared with control group, MAP at 5 days after treatment in Xuebijing group was significantly increased [mmHg (1 mmHg = 0.133 kPa): 74.9±10.7 vs. 70.2±6.6, P < 0.05], the dosage of NE was decreased [μg×kg-1×min-1: 0.01 (0.00, 0.22) vs. 0.10 (0.05, 0.80), P < 0.05], LVEF was significantly increased (0.617±0.125 vs. 0.533±0.129, P < 0.05), BNP was significantly decreased [ng/L: 117.3 (52.0, 443.0) vs. 277.2 (67.9, 2 370.2), P < 0.05], while VEGF showed no significant change (ng/L: 101.1±23.2 vs. 89.6±20.5, P > 0.05), and sFLT-1 was significantly decreased (ng/L: 245.7±86.2 vs. 295.1±95.1, P < 0.05). It was shown by Pearson coefficient bivariate correlation analysis that sFLT-1 was negatively correlated with MAP and ScvO2 (r = -0.569, P = 0.000; r = -0.341, P = 0.008) 5 days after treatment, while it was positively associated with Lac and acute physiology and chronic health evaluation II (APACHE II) score (r = 0.749, P = 0.000; r = 0.645, P = 0.000).

Topics: APACHE; Carbon Dioxide; Cardiac Output; Central Venous Pressure; Drugs, Chinese Herbal; Endothelium; Hemodynamics; Humans; Microcirculation; Natriuretic Peptide, Brain; Norepinephrine; Oximetry; Prospective Studies; Sepsis; Shock, Septic; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-1

To explore the protective effects of target blood glucose control on cardiac dysfunction in septic patients.. For this prospective and randomized interventional study, a total of 90 septic patients were divided into group A (blood glucose levels of 4.4 to 6.1 mmol/L), group B (6.1 to 8.3 mmol/L) and group C (8.3 to 10.0 mmol/L) (n = 30 each). And 30 non-septic subjects were selected into control group. Serial transthoracic echocardiogram (TTEs) was performed to measure left ventricle ejection fraction (LVEF) and ratio of blood flow velocity of mitral annulus during early diastole (E) and atrial contraction (A) before and 1, 3, 7 days after blood glucose control with insulin therapy. The plasma level of brain natriuretic peptide (BNP) was detected by enzyme-linked immunosorbent assay (ELISA). The patient records were reviewed to obtain information about demographics, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, incidence of hypoglycemia and 28-days survival rates.. No significant inter-group improvement existed in mean values of LVEFs (P = 0.184). And E/As differed among the groups and there was statistical difference between groups A and C (P = 0.005). There was a increasing trend for the levels of BNP of groups A, B and C. And comparison of group A with group B/C had statistical variability (PAB = 0.028, P(Ac) = 0.000). LVEFs had no variation (P₁= 0.310, P₃= 0.174) while E/A and BNP were significantly higher or lower in group A than those in others at Day 1 and 3 (P = 0.005). The LVEFs were similar at Day 7 and E/As and BNPs of groups A, B and C showed statistical differences. The variation of E/As with time differed between groups A, B and C.. Maintaining a target blood glucose of 4.4 to 6.1 mmol/L may improve cardiac dysfunction. Furthermore, it has more significant improvement of diastolic dysfunction than systolic counterpart. Combined utilization of LVEF, E/A and BNP is better in evaluating critical ill patients with sepsis-induced cardiomyopathy under target blood glucose control. It suggests that a glucose level of 4.4 to 6.1 mmol/L may benefit cardiac consistent dysfunction in septic patients during 7 days after treatment.

Topics: Blood Flow Velocity; Blood Glucose; Cardiovascular Physiological Phenomena; Echocardiography; Enzyme-Linked Immunosorbent Assay; Humans; Insulin; Mitral Valve; Natriuretic Peptide, Brain; Prospective Studies; Sepsis; Ventricular Function, Left

To compare the values of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) in acute phase of Kawasaki disease (KD), sepsis and other acute febrile illnesses.. We conducted a cross-sectional study on 40 KD patients and 40 age- and sex-matched controls with sepsis and other febrile illnesses between January, 2019 and June, 2020. Complete blood count, C-reactive protein (CRP), liver and renal function tests, serum electrolytes, chest X-ray, NT-proBNP level, Bactec blood culture, urine microscopy and culture along with detailed physical examination was done for all cases and control.. Mean (SD) values of NT-proBNP levels in acute KD was higher than sepsis/other febrile illnesses (914.9 vs 219 pg/mL; P=0.001). Also, the number of KD patients whose NT-proBNP was elevated were significantly higher compared to controls (70% vs 32.5%; P<0.001).. NT-proBNP may be useful as a biomarker in the diagnosis of acute phase KD.

Topics: Biomarkers; Cross-Sectional Studies; Humans; Microscopy; Mucocutaneous Lymph Node Syndrome; Natriuretic Peptide, Brain; Peptide Fragments; Sepsis; Urinalysis

The aim of this study was to explore the risk factors affecting the prognosis of patients with sepsis using a prospective design.. From January 2022 to March 2023, a prospective study was conducted in the Intensive Care Unit (ICU) of Cangzhou Central Hospital, including 58 patients who met the diagnostic criteria for sepsis. Patients were divided into a survival group (39 cases) and a death group (19 cases) based on outcome. Within 24 hours, the following indicators were collected: gender, age, underlying diseases, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, cardiac troponin I (cTnI), B-type natriuretic peptide (BNP), lactate, procalcitonin, ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), systolic velocity (S'), and global longitudinal strain/strain rate (GLS/GLSr) and global circumferential strain/strain rate (GCS/GCSr) by speckle tracking. Logistic regression analysis was used to evaluate the risk factors for mortality in septic patients, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of various risk factors for sepsis-related death.. There was no significant difference in gender, age, underlying diseases, BNP, procalcitonin, EF, TAPSE, S', GLSr, GCS, or GCSr between the two groups (p>0.05). There were statistically significant differences in APACHE II score, SOFA score, cTnI, lactate, and GLS between the two groups (p<0.05). Logistic regression analysis showed that SOFA score (OR=2.32, 95% CI: 1.067-5.289, p<0.05), cTnI (OR=1.19, 95% CI: 1.001-1.312, p<0.05), and GLS (OR=1.58, 95% CI: 1.012-2.721, p<0.05) were risk factors for sepsis-related death (p<0.05). The areas under the ROC curves for SOFA score, cTnI, and GLS were 0.769, 0.757, and 0.846, respectively.. SOFA score, cTnI, and GLS are independent risk factors for mortality in patients with sepsis. Among these factors, GLS has the highest predictive value for patient prognosis. Therefore, when predicting the prognosis of patients with sepsis, the assessment of right ventricular ultrasound can be used in clinical practice.

Topics: Biomarkers; Humans; Lactic Acid; Natriuretic Peptide, Brain; Peptide Hormones; Procalcitonin; Prognosis; Prospective Studies; Sepsis

This study aims to evaluate the role of cardiac enzymes N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin-I (CTnI) as predictors of outcomes in patients with sepsis.78 cases with a diagnosis of sepsis were enrolled over a 2-year period. Baseline demographic, Acute Physiology and Chronic Health Evaluation-II (APACHE-II), Simplified Acute Physiology Score-II (SAPS-II), hematologic and biochemical parameters were noted. Serum NT-proBNP and CTnI were evaluated at 24 and 72 hours of admission along with echocardiography. Patients were prospectively followed up until death or discharge.Mean APACHE-II score was 19.8±9.6 and SAPS-II was 44.8±17.2. Survival rate in the study was 47.5% (36 of 78 patients). NT-proBNP was significantly higher in non-survivors with values over 4300 pg/mL at 24 hours and 5229 pg/mL at 72 hours associated with poor outcomes (p<0.05). CTnI was higher among non-survivors than in survivors, but the difference was not significant. APACHE-II score combined with NT-proBNP predicted a poor outcome in 51.2% cases compared with 14.6% cases with APACHE-II alone (p<0.05), while SAPS-II combined with NT-proBNP predicted a poor outcome in 53.6% cases as compared with 9.6% cases with SAPS-II alone (p<0.05). SAPS-II greater than 45 and NT-proBNP values at 72 hours were independent predictors of mortality in patients with sepsis.NT-proBNP is an independent predictor of mortality in patients with sepsis and its combination with APACHE-II and SAPS-II improves the predictive values of the scoring systems.

Topics: Adult; Aged; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Sepsis; Troponin I

The aim of this study was to assess the role of prehospital point-of-care. A prospective, emergency medical service-delivered, prognostic, cohort study of adults evacuated by ambulance and admitted to emergency department between January 2020 and May 2021. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on the validation cohort.. A total of 1,360 patients were enrolled with medical disease in the study. The occurrence of sepsis, septic shock, and in-hospital sepsis-related mortality was 6.4% (67 cases), 4.2% (44 cases), and 6.1% (64 cases). Prehospital National Early Warning Score 2 had superior predictive validity than quick Sequential Organ Failure Assessment and. The incorporation of

Topics: Aged; Emergency Medical Services; Emergency Service, Hospital; Female; Hospital Mortality; Hospitalization; Humans; Male; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Sepsis

The aim is to examine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with major burns and sepsis. We collected the data of major burn patients who were admitted to our department. We compared the age, sex, burn area, burn depth, length of hospitalization, and mortality rate between the sepsis group and non-sepsis group and compared NT-proBNP, procalcitonin (PCT), platelet count, Sequential Organ Failure Assessment (SOFA) score, and quick SOFA (qSOFA) score between the survivors and nonsurvivors in the sepsis group. Receiver operating characteristic (ROC) curves were used in sepsis patients to evaluate the prognostic value of NT-proBNP, PCT, SOFA score, qSOFA score, etc. Kaplan-Meier survival curves were used to compare the 90-day survival curves of patients. Logistic regression analysis was used to analyze the risk factors that affect the prognosis of sepsis patients. There were 90 major burn patients with sepsis and 114 major burn patients without sepsis. The mortality rate for the major burn sepsis group was significantly higher than that for the non-sepsis group. The NT-proBNP level in sepsis patients in the nonsurvivor group was 2900 pg/ml, which was significantly higher than that in patients in the survivor group. Survival analysis showed that the mean survival time for the NT-proBNP >2000 pg/ml group was 15.08 days. Multivariate regression analysis indicated that NT-proBNP was an independent risk factor for mortality in burn patients with sepsis. NT-proBNP can be used as a prognostic marker in patients with major burns and sepsis.

Topics: Biomarkers; Burns; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Procalcitonin; Prognosis; ROC Curve; Sepsis

In order to investigate the expression levels of procalcitonin (PCT), B-type brain natriuretic peptide (BNP), and lactic acid (Lac) in serum of patients with sepsis, a retrospective analysis is conducted. 80 sepsis patients admitted to the ICU of our hospital from January 2019 to June 2020 are selected, and the application value of these factors combined with Apache II score in early diagnosis and prediction of death risk is analyzed. All patients are classified into survival group (

Topics: Early Diagnosis; Humans; Lactic Acid; Natriuretic Peptide, Brain; Procalcitonin; Prognosis; Retrospective Studies; Sepsis

Acute heart failure is a syndrome defined as the new onset de novo heart failure or worsening [acutely decompensated heart failure (ADHF)] leading to symptoms and signs of HF, mostly related to systemic congestion as based on the European Society of Cardiology (ESC) definition. India has a huge burden of heart failure patients. Several factors have been identified as precipitating acute HF hospitalizations. These include myocardial ischemia, no adherence to medications, arrhythmias, infection, uncontrolled hypertension (HTN), anemia, renal impairment, and diet. However, there is a dearth of studies assessing their effect on mortality in patients admitted with acute heart failure. Many previous studies have shown that BNP and NT-pro-BNP are independent predictors of mortality and other cardiac outcomes in patients with heart failure (HF) and ADHF. However, no studies have provided any clear direction with respect to the critical cut-off values that suggest high mortality. Comprehensive knowledge of the correlation of Pro-BNP and precipitating factors of heart failure with mortality can help in prognostication and clinical management of AHF patients.. This was a prospective observational cross-sectional study conducted in the Emergency Department of the Postgraduate Institute of Medical Education and Research, Chandigarh which is a teaching and research hospital located in North India. Patients were enrolled from 1st August 2021 to 28th February 2022. Patients who met inclusion criteria were enrolled; they were followed for 5 days. After 5 days outcomes were recorded. Various precipitating factors for hospitalization were identified and their clinical impact on mortality was noted. Pro-BNP values were obtained at admission and their correlation with mortality and patient outcome after 5 days was noted. Values of Pro-BNP were compared among those who survived after 5 days vs. those who had fatal outcomes.. The most common precipitating factor for AHF was poor medical compliance which did not affect mortality. It was followed by sepsis which significantly increases mortality in patients of AHF. ACS was also an important precipitating factor for AHF, though it had no effect on mortality. The mortality in the group of patients with very high Pro-BNP levels ≥ 2000 pg/ml was significantly higher than in the group of patients who had moderately elevated Pro-BNP < 2000 pg/ml. The median value of Pro-BNP was significantly higher in patients who had fatal outcomes [3670 (IQR- 2745 to 3980)] as compared to patients who survived after 5 days of hospitalization [1340 (IQR- 987 to 1670)].. Poor compliance with medications and sepsis are the most common precipitating factors for acute heart failure in north Indian patients. Sepsis as a precipitating factor is a significant risk factor for in-hospital mortality in acute heart failure patients presenting to the emergency department. Pro-BNP values above 2000 pg/ml in patients with acute heart failure requiring emergency admission are associated with a poor prognosis.

Topics: Acute Disease; Cross-Sectional Studies; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Precipitating Factors; Prognosis; Sepsis; Tertiary Care Centers

BACKGROUND The N-terminal fragment of proB-type natriuretic peptide (NT-proBNP) is an established predictive marker for sepsis-related mortality in adult. This retrospective study aimed to determine age-stratified cut-off values for serum levels of NT-proBNP and mortality from sepsis in children under 18 years. MATERIAL AND METHODS Patients were stratified by age as follows: <1 year, 1-3 years, 4-6 years, and 7-18 years (age groups). The control group consisted of age- and sex-matched healthy children. Serum NT-proBNP levels were detected by laboratory assays in the participants. The appropriate serum NT-proBNP cut-off values for predicting short-term mortality of the sepsis patients were calculated via receiver operating characteristic (ROC) curve analyses. RESULTS Among 327 pediatric patients with sepsis, the serum NT-proBNP cut-off concentrations for predicting sepsis-related mortality in the <1 year, 1-3 years, 4-6 years, and 7-18 years age groups were 5000 ng/L, 4500 ng/L, 4100 ng/L, and 3800 ng/L, respectively (P<0.001). The area under the ROC curve (AUC) values for these were 0.815, 0.812, 0.806 and 0.725, respectively (P<0.001). CONCLUSIONS This retrospective study provided the age range-specific serum NT-proBNP cut- off concentrations for predicting short-term mortality in children. In children <1 year, 1-3 years, 4-6 years, and 7-18 years, age-stratified cut-off values that predicted sepsis-associated mortality were 5000 ng/L, 4500 ng/L, 4100 ng/L, and 3800 ng/L, respectively.

Topics: Adolescent; Age Factors; Biomarkers; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; ROC Curve; Sepsis

Early identification of infection severity and organ dysfunction is crucial in improving outcomes of patients with sepsis. We aimed to develop a new combination of blood-based biomarkers that can early predict 28-day mortality in patients with sepsis or septic shock. We enrolled 66 patients with sepsis or septic shock and compared 14 blood-based biomarkers in the first 24 h after ICU admission. The serum levels of interleukin-6 (IL-6) (median 217.6 vs. 4809.0 pg/ml, P = 0.001), lactate (median 2.4 vs. 6.3 mmol/L, P = 0.014), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (median 1596.5 vs. 32,905.3 ng/ml, P < 0.001), prothrombin time (PT) (median 15.6 vs. 20.1 s, P = 0.030), activated partial thrombin time (APTT) (median 45.1 vs. 59.0 s, P = 0.026), and international normalized ratio (INR) (median 1.3 vs. 1.8, P < 0.001) were significantly lower in the survivor group. IL-6, NT-proBNP, and INR provided the best individual performance in predicting 28-day mortality of patients with sepsis or septic shock. Furthermore, the combination of these three biomarkers achieved better predictive performance (AUC 0.890, P < 0.001) than conventional scoring systems. In summary, the combination of IL-6, NT-proBNP, and INR may serve as a potential predictor of 28-day mortality in critically ill patients with sepsis or septic shock.

Topics: Aged; Aged, 80 and over; Biomarkers; Female; Humans; Intensive Care Units; Interleukin-6; International Normalized Ratio; Lactic Acid; Male; Middle Aged; Natriuretic Peptide, Brain; Partial Thromboplastin Time; Peptide Fragments; Prognosis; Prothrombin Time; Sepsis; Shock, Septic

BACKGROUND Serum lactate, troponin, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been proposed to be useful prognostic indicators in patients with sepsis and septic shock. This study aimed to evaluate the predictive ability of these biomarkers and assess how their prognostic utility may be improved by using them in combination. MATERIAL AND METHODS A retrospective review of the medical records of 1242 patients with sepsis and septic shock who were admitted to the Richmond University Medical Center between June 1, 2018, and June 1, 2019, was carried out; 427 patients met the study criteria and were included in the study. The primary outcome measures included 30-day mortality, APACHE II scores, length of hospital stay, and admission to the Medical Intensive Care Unit (MICU). RESULTS High levels of lactate (>4 mmol/L), troponin (>0.45 ng/mL), and NT-proBNP (>8000 pg/mL) were independent predictors of 30-day mortality, with an adjusted odds ratio of mortality being 3.19 times, 2.13 times, and 2.5 times higher, respectively, compared with corresponding reference groups, at 95% confidence intervals. Elevated levels of lactate, troponin, and NT-proBNP were associated with 9.12 points, 7.70 points, and 8.88 points in higher APACHE II scores, respectively. Only elevated troponin levels were predictive of a longer length of hospital stay. In contrast, elevated lactate and troponin were associated with an increased chance of admission to the MICU. CONCLUSIONS Elevated levels of serum lactate, troponin, and NT-proBNP are independent predictors of mortality and higher APACHE II scores in patients with sepsis and septic shock.

Topics: Biomarkers; Humans; Lactic Acid; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; Sepsis; Shock, Septic; Troponin

This article aimed to study the value of brain natriuretic peptide (BNP) and cardiac troponin I(cTnI) for predicting the prognosis in cancer patients with sepsis.. A cohort of 233 cancer patients with sepsis admitted to our ICU from January 2017 to October 2020 was included in this retrospective study. The data of BNP and cTnI on the first day (d1) and the third day(d3) after entering ICU, blood lactate (Lac), procalcitonin (PCT), Leucocyte and Sequential Organ failure assessment (SOFA) scores within 24 hr of entering ICU, the incidence of septic shock, acute kidney injury(AKI), acute respiratory failure (ARF) or sepsis-induced myocardial dysfunction(SIMD) in ICU, fluid balance in 24 hr and 72 hr after entering ICU, time of mechanical ventilation(MV), length of stay, emergency surgery were collected. According to 28-day mortality, patients were divided into survival group (190 cases) and death group (43 cases). All the above variables were compared.. BNP was an independent predictor for the mortality in these patients (P < 0.05).While cTnI was not. BNP on d3 in 681.5 pg/ml predicted the mortality with a sensitivity of 91.5 % and a specificity of 88.7 %. All patients were divided into the new two groups following the cutoff value of BNP on d3(681.5pg/ml), and the survival curve showed a significant difference with Kaplan-Meier analysis (P < 0.05). BNP had statistical differences between four groups based on the comorbidities(septic shock, AKI, ARF or SIMD), but cTnI was not.. BNP was a great predictor for the prognosis of cancer patients with sepsis, while cTnI was not.

Topics: Biomarkers; Cohort Studies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Neoplasms; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Sepsis; Survival Analysis; Troponin I

To study the predictive value of B-type natriuretic peptide (BNP) and soluble thrombomodulin (sTM) in the severity stratification and prognosis evaluation of sepsis.. The clinical data of 137 sepsis patients diagnosed and treated in Sichuan Provincial People's Hospital from May 2018 to November 2020 were retrospectively analyzed. Meanwhile, 121 healthy individuals were selected as the control group. Patients with sepsis were allocated into the mild group, severe group, and shock group according to the severity. According to the 28-day prognosis, the patients were allocated into the death group and survival group. The plasma BNP and serum sTM levels in different groups were compared, and their prognostic value was evaluated.. Patients with sepsis had significantly higher levels of BNP and sTM than the healthy control group (P<0.05). The levels of BNP and sTM in the mild group were significantly lower than those in the severe group and shock group, and both BNP and sTM were positively correlated with Acute Physiology and Chronic Health Status (APACHE) II score (r=0.595, 0.516, P<0.05). The levels of BNP and sTM in the death group were significantly higher than those in the survival group (P<0.05). The area under curve (AUC) of BNP combined with sTM was significantly greater than that of BNP or sTM alone for the prognosis of sepsis (P<0.05). When the cut-off value of BNP was 625.68 pg/mL, the sensitivity and specificity were 77.42% and 89.42%, respectively. When the cut-off value of sTM was 10.53 ng/mL, the sensitivity and specificity were 83.87% and 94.34%, respectively.. Patients with sepsis have significantly higher serum BNP and sTM levels which are positively correlated with the severity of the disease. Both of the 2 indexes have good prognostic value, and the predictive value is higher when combined.

Topics: Humans; Natriuretic Peptide, Brain; Prognosis; Retrospective Studies; Sepsis; Thrombomodulin

The utility of biochemical marker analysis in forensic autopsy cases is still uncertain due to the postmortem changes which they undergo. Thus, research is required to elucidate alternative samples and biochemical markers which are less affected by postmortem changes. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) are known to be elevated in congestive heart failure (CHF), acute myocardial infarction (AMI), and sepsis patients. Although NT-proBNP is reportedly excreted into the urine, no study has previously evaluated the diagnostic efficacy of urinary concentrations in a forensic setting. The aim of this study was to evaluate the diagnostic efficacy of NT-proBNP concentration in urine obtained postmortem in a series of forensic autopsy cases.. Urinary NT-proBNP was measured in 36 AMI, 10 CHF, and 19 sepsis cases, and in 124 control cases (all with postmortem interval [PMI]<72h).. Urinary NT-proBNP was significantly higher in AMI, CHF, and sepsis cases than in control cases. Cut-off values for diagnosing AMI, CHF, and sepsis-related fatalities were 98 (sensitivity, 55.6 %; specificity, 73.4 %), 1050 (sensitivity, 80.0 %; specificity, 94.4 %), and 363pg/mL (sensitivity, 84.2 %; specificity, 85.5 %), respectively. Furthermore, we subdivided the control cases according to the death process as either acute death (87 cases) or prolonged death cases (37 cases). Although urine NT-proBNP of CHF and sepsis cases were significantly higher compared with both cases, the concentration in the AMI cases were significantly high only when compared with the acute death cases.. This study is the first to elucidate the diagnostic utility of NT-proBNP measurement in urine obtained postmortem in a series of causes of death. This study suggests the diagnostic efficacy for AMI, CHF, and sepsis-related fatality in cases in which the PMI was within 72h.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Cause of Death; Child; Creatine Kinase, MB Form; Female; Forensic Medicine; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Pericardial Fluid; Postmortem Changes; Sensitivity and Specificity; Sepsis; Troponin; Young Adult

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Sepsis

There is little information in the sepsis treatment guidelines on the prevention and treatment of cognitive dysfunction after sepsis. This study aimed to explore whether Recombinant human brain natriuretic peptide (rhBNP) has protective effects against sepsis-associated encephalopathy (SAE) in a mouse model. The results showed that 50 μg/kg of rhBNP significantly improved the 14-day survival of cecal ligation and puncture (CLP)-induced septic mice and mitigated cognitive dysfunction and anxiety. Fourteen days after CLP surgery, septic mice showed increased BBB permeability and neuronal apoptosis. rhBNP treatment significantly reduced pathological changes in the brain of CLP mice. Meanwhile, rhBNP therapy also reduced the level of inflammatory cytokines in the hippocampus, possibly via inhibiting the TLR4-NF-κB pathway. These results indicate that rhBNP may be a promising drug for the treatment of SAE.

Topics: Animals; Apoptosis; Blood-Brain Barrier; Brain; Brain Diseases; Disease Models, Animal; Humans; Male; Mice; Mice, Inbred C57BL; Natriuretic Peptide, Brain; Neurons; NF-kappa B; Recombinant Proteins; Sepsis; Signal Transduction; Toll-Like Receptor 4

Topics: Humans; Muscle Strength; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis; Survivors

B-type natriuretic peptide (BNP) is secreted by ventricular cardiomyocytes in response to various types of cardiac stress and has been used as a heart failure marker. In septic patients, increased BNP suggests poor prognosis; however, no causal link has been established. Among various effects, BNP decreases systemic vascular resistance and increases natriuresis that leads to lower blood pressure. We previously observed that JNK inhibition corrects cardiac dysfunction and suppresses cardiac BNP mRNA in endotoxemia. In this study, we investigated the transcriptional mechanism that regulates BNP expression and the involvement of plasma BNP in causing septic hypotension. Our in vitro and in vivo findings confirmed that activation of JNK signaling increases BNP expression in sepsis via direct binding of c-Jun in activating protein-1 (AP-1) regulatory elements of the Nppb promoter. Accordingly, genetic ablation of BNP, as well as treatment with a potentially novel neutralizing anti-BNP monoclonal antibody (19B3) or suppression of its expression via administration of JNK inhibitor SP600125 improved cardiac output, stabilized blood pressure, and improved survival in mice with polymicrobial sepsis. Therefore, inhibition of JNK signaling or BNP in sepsis appears to stabilize blood pressure and improve survival.

Topics: Animals; Cell Line; Humans; Hypotension; JNK Mitogen-Activated Protein Kinases; Mice; Natriuretic Peptide, Brain; Sepsis; Up-Regulation

To describe the clinical profiles and risk factors for critical illness in hospitalized children and adolescents with coronavirus disease 2019 (COVID-19).. Children 1 month to 21 years of age with COVID-19 from a single tertiary care children's hospital between March 15 and April 13, 2020 were included. Demographic and clinical data were collected.. In total, 67 children tested positive for COVID-19; 21 (31.3%) were managed as outpatients. Of 46 admitted patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent but not significantly associated with PICU admission (P = .99). Admission to the PICU was significantly associated with higher C-reactive protein, procalcitonin, and pro-B type natriuretic peptide levels and platelet counts (P < .05 for all). Patients in the PICU were more likely to require high-flow nasal cannula (P = .0001) and were more likely to have received Remdesivir through compassionate release (P < .05). Severe sepsis and septic shock syndromes were observed in 7 (53.8%) patients in the PICU. Acute respiratory distress syndrome was observed in 10 (77%) PICU patients, 6 of whom (46.2%) required invasive mechanical ventilation for a median of 9 days. Of the 13 patients in the PICU, 8 (61.5%) were discharged home, and 4 (30.7%) patients remain hospitalized on ventilatory support at day 14. One patient died after withdrawal of life-sustaining therapy because of metastatic cancer.. We describe a higher than previously recognized rate of severe disease requiring PICU admission in pediatric patients admitted to the hospital with COVID-19.

Topics: Adenosine Monophosphate; Adolescent; Alanine; Antiviral Agents; Asthma; Betacoronavirus; Blood Urea Nitrogen; C-Reactive Protein; Child; Child, Preschool; Coronavirus Infections; COVID-19; Creatinine; Critical Illness; Dyspnea; Female; Hospitalization; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Male; Natriuretic Peptide, Brain; New York City; Pandemics; Pediatric Obesity; Platelet Count; Pneumonia, Viral; Procalcitonin; Respiration, Artificial; Retrospective Studies; SARS-CoV-2; Sepsis; Shock, Septic; Tertiary Care Centers; Young Adult

The present study was to evaluate the feasibility of using the multi-biomarker strategy for the prediction of sepsis-induced myocardial dysfunction (SIMD) and mortality in septic patients.. Brain natriuretic peptide (BNP), cardiac troponin I (cTnI), and heart-type fatty acid-binding protein (h-FABP) in 147 septic patients were assayed within 6 h after admission. We also determined the plasma levels of myeloperoxidase (MPO) and pregnancy-associated plasma protein-A (PAPP-A). The receiver operating characteristic (ROC) curve was used to assess the best cutoff values of various single-biomarkers for the diagnosis of SIMD and the prediction of mortality. Also, the ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) indices were used to evaluate the feasibility of using multi-biomarkers to predict SIMD and mortality.. Our statistics revealed that only h-FABP independently predicted SIMD (P<0.05). The addition of MPO and cTnI to h-FABP for SIMD prediction provided an NRI of 18.7% (P=0.025) and IDI of 3.3% (P=0.033). However, the addition of MPO or cTnI to h-FABP did not significantly improve the predictive ability of h-FABP to SIMD, as evidenced by the area under the curve (AUC), NRI, and IDI (all P>0.05). A history of shock and MPO were independent predictors of mortality in septic patients (both P<0.05). The addition of PAPP-A and h-FABP to MPO resulted in a mortality prediction with NRI of 25.5% (P=0.013) and IDI of 2.9% (P=0.045). However, this study revealed that the addition of h-FABP or PAPP-A to MPO did not significantly improve the ability to predict mortality, as evidenced by the AUC, NRI, and IDI (all P>0.05).. The findings of this study indicate that a sensitive and specific strategy for early diagnosis of SIMD and mortality prediction in sepsis should incorporate three biomarkers.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Cardiomyopathies; Fatty Acid-Binding Proteins; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peroxidase; Pregnancy-Associated Plasma Protein-A; Sepsis; Troponin I

To investigate the significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the early assessment of neonatal cardiac dysfunction in sepsis.. The children diagnosed with neonatal sepsis and common infection neonates admitted to the department of pediatric neonatal intensive care unit (NICU) of Liaocheng People's Hospital from January 2016 to January 2019 were enrolled. Data of clinical sign, laboratory results, bedside echocardiography and survival data were collected, and the differences of clinical indexes were compared among sepsis patients with and without cardiac dysfunction and common infection. The risk factors of sepsis with cardiac dysfunction were analyzed by multivariate Logistic regression, and the early prediction value of NT-proBNP for neonatal septic cardiac dysfunction was evaluated by the receiver operating characteristic (ROC) curve.. NT-proBNP can be used as a diagnostic marker of early cardiac dysfunction, and for rapid diagnosis of neonatal cardiac dysfunction in sepsis. The application may guide clinicians to use drugs better to improve cardiac function and treatment effect.

Topics: Biomarkers; Heart Diseases; Humans; Infant, Newborn; Natriuretic Peptide, Brain; Peptide Fragments; ROC Curve; Sepsis; Stroke Volume; Ventricular Function, Left

As a well-known cardioprotective factor, the relevance of adiponectin (APN) to heart function following sepsis remains largely unknown. The present study evaluated the effects of plasma APN levels on heart function and 28-day mortality in sepsis patients.. This was a prospective study that was performed with 98 patients with sepsis and 32 controls. Left ventricular systolic dysfunction (LVSD) was defined as a left ventricular ejection fraction (LVEF) ≤ 45% based on echocardiography. The effects of APN on the development of sepsis-related LVSD and prediction of 28-day mortality were evaluated.. Plasma APN levels significantly decreased in sepsis patients compared with controls, with rising severity of illness, and positively correlated with the LVEF and stroke volume index. Sepsis patients with LVSD had lower APN levels than patients without LVSD. According to the receiver operating characteristic curve, plasma APN levels had the comparable value in prediction of LVSD incidence than those conditional factors, including brain natriuretic peptide (BNP) and highly sensitive cardiac troponin T (hsTnT). Twenty-three of the 98 sepsis patients (23.47%) died at 28 days. Adiponectin levels were an independent predictive factor for 28-day mortality.. Low APN levels were associated with the incidence of LVSD and 28-day mortality in sepsis patients. Adiponectin may be a novel factor that may be useful for the diagnosis of LVSD.

Topics: Adiponectin; Adolescent; Adult; Aged; Aged, 80 and over; Beijing; Biomarkers; Comorbidity; Echocardiography; Female; Humans; Incidence; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Prospective Studies; ROC Curve; Sepsis; Stroke Volume; Ventricular Dysfunction, Left; Young Adult

Topics: Adrenomedullin; Biomarkers; C-Reactive Protein; Female; Humans; LDL-Receptor Related Protein-Associated Protein; Male; Middle Aged; Natriuretic Peptide, Brain; Neoplasm Proteins; Osteopontin; Peptide Fragments; Predictive Value of Tests; Procalcitonin; Protein Precursors; Proteoglycans; Renal Replacement Therapy; Reproducibility of Results; Sepsis; Serum Amyloid P-Component

Using biomarkers to predict mortality in patients with sepsis is important because these patients frequently have high mortality rates and unsatisfactory outcomes. The performance of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein (CRP) to predict clinical outcomes in elderly sepsis patients is unimpressive. We aimed to assess the prognostic value of NT-pro-BNP, CRP and the combination of both in selected medical ICU sepsis patients more than 75 years old.. In total, 245 consecutive patients were screened for eligibility and followed during their ICU stays. We collected the patients' baseline characteristics, including their Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and NT-pro-BNP and CRP levels. The primary outcome was ICU mortality. Potential predictors were analyzed for their possible associations with the outcome. We also evaluated the ability of NT-pro-BNP and CRP levels combined with the APACHE II score to predict ICU mortality by calculating the C-index and net reclassification improvement (NRI).. Univariate regression revealed that CRP, NT-pro-BNP, APACHE II score, lactic acid level, NEU count(neutrophil count)and HCT level independently predicted ICU mortality (all P < 0.01). The C-index for the prediction of ICU mortality by the APACHE II score (0.847 ± 0.029; P < 0.001) was greater than that for NT-pro-BNP (0.673 ± 0.039; P < 0.01) or CRP (0.626 ± 0.039; P < 0.01) (all P < 0.01). Compared with the APACHE II score (0.847 ± 0.029; P < 0.001), the combination of CRP (0.849 ± 0.029; P < 0.01) or NT-pro-BNP (0.853 ± 0.028; P < 0.01) or both (0.853 ± 0.030; P < 0.01) with the APACHE II score did not significantly increase the C-index for predicting ICU mortality (all P > 0.05). However, the addition of NT-pro-BNP to the APACHE II score gave an NRI of 8.6% (P = 0.000), the addition of CRP to the APACHE II score provided an NRI of 11.34% (P = 0.012), and the addition of both markers to the APACHE II score yielded an NRI of 29.0% (P = 0.000). In the MOF subgroup (N = 118), CRP (OR = 2.62, P < 0.05) but not NT-pro-BNP (OR = 1.73, p > 0.05) independently predicted ICU mortality, and the addition of CRP to the APACHE II score obviously increased its predictive ability (NRI = 13.88%, P = 0.000). In the non-MOF group (N = 127), neither CRP (OR = 5.447, P = 0.078) nor NT-pro-BNP (OR = 2.239, P = 0.016) was an independent predictor of ICU mortality.. In sepsis patients older than 75 years, NT-pro-BNP and CRP can serve as independent predictors of mortality, and the addition of NT-pro-BNP or CRP or both to the APACHE II score significantly improves the ability to predict ICU mortality. CRP appears to be useful for predicting ICU outcomes in elderly sepsis patients with multiple-organ failure.

Topics: Aged; APACHE; Biomarkers; C-Reactive Protein; Female; Humans; Intensive Care Units; Lactic Acid; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Sepsis

Topics: Humans; Muscle Strength; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis; Survivors

Mid-regional pro atrial natriuretic peptide (MR-proANP) is an established biomarker for heart failure, based on its key role in regulating homeostasis of water balance and blood pressure. The aim of the study was to determine the value of MR-proANP as a clinical biomarker in critical illness and/or sepsis. Upon admission to the medical intensive care unit (ICU), we investigated MR-proANP plasma concentrations in 217 critically ill patients (144 with sepsis, 73 without sepsis). Results were compared with 65 healthy controls.. MR-proANP plasma levels were significantly elevated in critically ill patients, when compared to healthy controls. Notably, MR-proANP levels were significantly higher in ICU patients with sepsis. MR-proANP levels were not associated with metabolic comorbidities like diabetes or obesity. In critically ill patients, MR-proANP plasma concentrations correlated with inflammatory cytokines, markers of organ dysfunction and several adipocytokines, such as resistin, retinol-binding protein 4 (RBP4) and adiponectin. Importantly, high MR-proANP plasma levels were associated with mortality, as MR-proANP levels above 227.0 pmol/l indicated a particularly increased mortality risk in ICU patients. The association between MR-proANP and mortality was independent of single organ failure and inflammation markers.. Our study emphasizes the role of circulating MR-proANP as a biomarker in critically ill patients, in which high MR-proANP indicates organ dysfunction, sepsis and mortality risk. The association between high MR-proANP and inflammatory as well as adipose tissue-derived endocrine mediators warrants further pathophysiological investigations.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Comorbidity; Critical Illness; Diabetes Mellitus; Female; Humans; Inflammation; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Obesity; ROC Curve; Sepsis; Young Adult

Topics: Hospitalization; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Renal Insufficiency, Chronic; Sepsis

Echocardiography and cardiac biomarkers, such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are useful tools to evaluate cardiac dysfunction. Left ventricular systolic dysfunction (LVSD) is common in pediatric severe sepsis. The aim of this study is to evaluate the prognostic value of LVSD, cTnI, and NT-pro BNP for pediatric severe sepsis.A prospective, single center, observational study was conducted. Severe sepsis children were enrolled in the study from December 2015 to December 2016 in pediatric intensive care unit of Shanghai Children's Medical Center. Recorded general information, transthoracic echocardiography were performed at day 1, 2, 3, 7, and 10, using Simpson to measure left ventricular end-diastolic dimension and left ventricular end-systolic dimension, obtained echocardiography parameters: left ventricular ejection fraction (LVEF), left ventricular fractional shortening, left ventricular end-diastolic volume, left ventricular end- systolic volume, stroke volume, cardiac output. At the same time collecting the blood sample to measure cTnI, NT-pro BNP. The definition of LVSD was LVEF <50%. According to the prognosis of 28 days, children with severe sepsis were divided into survived group and nonsurvived group.Total of 50 pediatric patients who were diagnosed with severe sepsis (including septic shock) were enrolled, the incidence of LVSD was 52%. The 28-day mortality rate of severe sepsis was 34%. Multivariate logistic regression analyses for predictors of death in pediatric severe sepsis revealed that the 28-day mortality of severe sepsis was associated with mechanical ventilation (MV) within the first 6 hours of admission (odds ratio [OR], 0.01; 95% confidence interval [CI], 0.00-0.07) and total MV time (OR, 0.81; 95% CI, 0.68-0.97). The receiver operating characteristic curves LVEF (area under curve = 0.526), cTnI (area under curve = 0.480), and NT-pro BNP (area under curve = 0.624) were used to predict the 28-day mortality in pediatric severe sepsis. Follow-up echocardiography parameters for survived group and nonsurvived group showed no significant changes in LVEF, LVFS, stroke volume index, cardiac index (CI), left ventricular end-diastolic volume index and left ventricular end-systolic volume index at day 1, 2, 3, 7, and 10, except for CI at day 1 and 2. Kaplan-Meier plot of 28-day mortality and LVSD in pediatric severe sepsis showed there were no statistical differences (χ = 0.042, P = .837).L

Topics: Biomarkers; Child; Child, Preschool; Echocardiography; Female; Hospital Mortality; Humans; Logistic Models; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Sepsis; Systole; Troponin I; Ventricular Dysfunction, Left; Ventricular Function, Left

BACKGROUND This study investigated the changes in plasma brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels in pediatric patients with sepsis, and explored their relationships with serum inflammatory factors in pediatric patients. MATERIAL AND METHODS A total of 120 pediatric patients with sepsis admitted to and treated at our hospital from 2013 to 2017 were divided into 4 groups: a systemic inflammatory response syndrome (SIRS) group (n=28), a sepsis group (n=35), a severe sepsis group (n=27), and a septic shock group (n=30). Plasma BNP, cTnI, and creatine kinase-MB (CK-MB) levels in pediatric patients in the 4 groups were measured, and the correlations of BNP and cTnI with plasma inflammatory factors C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) were investigated. RESULTS The plasma BNP and cTnI levels in pediatric patients with sepsis were significantly higher than those in the SIRS group (p<0.05). After hospitalization and treatment, levels of BNP and cTnI in pediatric patients were decreased. The concentrations of BNP and cTnI were correlated with CRP level (r=0.88 and 0.88, respectively). The associations (r value) of BNP and cTnI with TNF-alpha levels were 0.35 and 0.48, respectively. CONCLUSIONS The levels of plasma BNP and cTnI are associated with the severity of sepsis in pediatric patients, and were positively correlated with CRP and TNF-alpha levels, which provides a novel strategy for the early diagnosis and evaluation of sepsis in pediatric patients.

Topics: Biomarkers; C-Reactive Protein; Child; Child, Preschool; Creatine Kinase, MB Form; Female; Humans; Male; Natriuretic Peptide, Brain; Prognosis; Sepsis; Shock, Septic; Troponin I; Tumor Necrosis Factor-alpha

Mean platelet volume (MPV) is a risk factor for cardiovascular and inflammatory diseases.. To evaluate the association between high MPV and 90-day mortality after an episode of venous thromboembolism (VTE).. Retrospective cohort of 594 patients with a median age of 73 years (58% women) with a first episode VTE, included in an institutional Thromboembolic Disease registry between 2014 and 2015. MPV values were obtained from the automated blood cell count measured at the moment of VTE diagnosis. Volumes ≥ 11 fL were classified as high. All patients were followed for 90 days to assess survival.. The main comorbidities were cancer in 221 patients (37%), sepsis in 172 (29%) and coronary artery disease in 107 (18%). Median MPV was 8 fl (8-9), brain natriuretic peptide 2,000 pg/ml (1,025-3,900) and troponin 40 pg/ml (19.5-75). Overall mortality was 20% (121/594) during the 90 days of follow-up. Thirty three deaths occurred within 7 days and 43 within the first month. The loss of patients from follow-up was 5% (28/594) at 90 days. Mortality among patients with high MP was 36% (23/63). The crude mortality hazard ratio (HR) for high MPV was 2.2 (95% confidence intervals (CI) 1.4-3.5). When adjusted for sepsis, oncological disease, heart disease, kidney failure and surgery, the mortality HR of high MPV was 2.4 (CI95% 1.5-3.9) in the VTE group, 2.3 (CI95% 1.5-4.4) in the deep venous thrombosis group, and 2.9 (CI95% 1.6 -5.6) in the pulmonary embolism group.. High MPV is an independent risk factor for mortality following an episode of VTE.

Topics: Acute Disease; Aged; Aged, 80 and over; Blood Platelets; Female; Follow-Up Studies; Humans; Male; Mean Platelet Volume; Middle Aged; Natriuretic Peptide, Brain; Neoplasms; Peptide Fragments; Prognosis; Pulmonary Embolism; Retrospective Studies; Risk Assessment; Risk Factors; Sepsis; Survival Analysis; Troponin; Venous Thromboembolism; Venous Thrombosis

Background Sepsis is the overwhelming host response to infection leading to shock and multiple organ dysfunction. Cardiovascular complications greatly increase sepsis-associated mortality. Although murine models are routinely used for preclinical studies, the benefit of using genetically engineered mice in sepsis is countered by discrepancies between human and mouse sepsis pathophysiology. Therefore, recent guidelines have called for standardization of preclinical methods to document organ dysfunction. We investigated the course of cardiac dysfunction and myocardial load in different mouse models of sepsis to identify the optimal measurements for early systolic and diastolic dysfunction. Methods and Results We performed speckle-tracking echocardiography and assessed blood pressure, plasma inflammatory cytokines, lactate, B-type natriuretic peptide, and survival in mouse models of endotoxemia or polymicrobial infection (cecal ligation and puncture, [ CLP ]) of moderate and high severity. We observed that myocardial strain and cardiac output were consistently impaired early in both sepsis models. Suppression of cardiac output was associated with systolic dysfunction in endotoxemia or combined systolic dysfunction and reduced preload in the CLP model. We found that cardiac output at 2 hours post- CLP is a negative prognostic indicator with high sensitivity and specificity that predicts mortality at 48 hours. Using a known antibiotic (ertapenem) treatment, we confirmed that this approach can document recovery. Conclusions We propose a non-invasive approach for assessment of cardiac function in sepsis and myocardial strain and strain rate as preferable measures for monitoring cardiovascular function in sepsis mouse models. We further show that the magnitude of cardiac output suppression 2 hours post- CLP can be used to predict mortality.

Topics: Animals; Biomarkers; Cardiac Output; Cardiomyopathies; Cytokines; Disease Models, Animal; Disease Progression; Echocardiography, Doppler; Inflammation Mediators; Lactic Acid; Male; Mice, Inbred C57BL; Myocardial Contraction; Natriuretic Peptide, Brain; Predictive Value of Tests; Risk Factors; Sepsis; Time Factors; Ventricular Function, Left

Sepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There is a need to identify biomarkers that can predict long-term worsening of physical function to be able to act early and prevent mobility loss. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-accepted biomarker of cardiac overload, but it has also been shown to be associated with long-term physical function decline. We explored whether NT-proBNP blood levels in the acute phase of sepsis are associated with physical function and muscle strength impairment at 6 and 12 months after sepsis onset.. This is a retrospective analysis conducted in 196 sepsis patients (aged 18-86 years old) as part of the University of Florida (UF) Sepsis and Critical Illness Research Center (SCIRC) who consented to participate in the 12-month follow-up study. NT-proBNP was measured at 24 h after sepsis onset. Patients were followed to determine physical function by short physical performance battery (SPPB) test score (scale 0 to12-higher score corresponds with better physical function) and upper limb muscle strength by hand grip strength test (kilograms) at 6 and 12 months. We used a multivariate linear regression model to test an association between NT-proBNP levels, SPPB, and hand grip strength scores. Missing follow-up data or absence due to death was accounted for by using inverse probability weighting based on concurrent health performance status scores. Statistical significance was set at p ≤ 0.05.. After adjusting for covariates (age, gender, race, Charlson comorbidity index, APACHE II score, and presence of CCI condition), higher levels of NT-proBNP at 24 h after sepsis onset were associated with lower SPPB scores at 12 months (p < 0.05) and lower hand grip strength at 6-month (p < 0.001) and 12-month follow-up (p < 0.05).. NT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors.

Topics: Adult; Aged; Biomarkers; Female; Florida; Humans; Length of Stay; Male; Middle Aged; Morbidity; Muscle Strength; Natriuretic Peptide, Brain; Peptide Fragments; Physical Functional Performance; Predictive Value of Tests; Prognosis; Retrospective Studies; Sepsis; Survivors

Sepsis is a complex clinical syndrome leading to severe sepsis and septic shock. It is very common in the intensive care unit with high mortality. Thus, judging its prognosis is extremely important. Procalcitonin (PCT) and -N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are commonly elevated in sepsis patients, but only a few are discussed in the septic acute kidney injury patients (AKI) who received renal replacement therapy (RRT). Our study is aimed at investigating the prognostic value of PCT and NT-proBNP in septic AKI patients who received RRT.. This was a retrospective study of septic AKI patients who underwent RRT in a Chinese university hospital. All enrolled patients tested PCT and NT-proBNP at RRT initiation. PCT and NT-proBNP levels were compared between the survivors and non-survivors. Receiver operating characteristic (ROC) curves of the 2 biomarkers were performed for predicting in-hospital mortality. According to the median value of PCT (16.2 ng/mL) and NT-proBNP (10,271 pg/mL), patients were divided into 4 groups (low PCT and low NT-proBNP; high PCT and low NT-proBNP; low PCT and high NT-proBNP; high PCT and high NT-proBNP). The Kaplan-Meier survival curves were used to analyze the 28-day survival rate in the 4 groups.. A total of 81 patients were enrolled in the study. Of which, 48 (59.3%) patients died during hospitalization. The median of NT-proBNP in non-survivors was significantly higher than in survivors (p = 0.001), while PCT had no significant difference (p = 0.412). The area under the ROC curve of PCT and NT-proBNP for predicting in-hospital mortality was 0.561 (95% CI 0.426-0.695) and 0.729 (95% CI 0.604-0.854). Kaplan-Meier survival curve analysis showed that increased NT-proBNP level was associated with 28-day mortality while combined with PCT there was no statistical difference in 4 different level groups.. NT-proBNP has a certain predictive value for the prognosis in septic AKI patients who received RRT. It seems that the initial PCT value for prognosis is limited. The combination of PCT and -NT-proBNP to evaluate the prognosis in these critically ill patients is currently unclear.

Topics: Acute Kidney Injury; Adult; Aged; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Procalcitonin; Prognosis; Renal Replacement Therapy; ROC Curve; Sepsis

Intravenous fluids, an essential component of sepsis resuscitation, may paradoxically worsen outcomes by exacerbating endothelial injury. Preclinical models suggest that fluid resuscitation degrades the endothelial glycocalyx, a heparan sulfate-enriched structure necessary for vascular homeostasis. We hypothesized that endothelial glycocalyx degradation is associated with the volume of intravenous fluids administered during early sepsis resuscitation.. We used mass spectrometry to measure plasma heparan sulfate (a highly sensitive and specific index of systemic endothelial glycocalyx degradation) after 6 h of intravenous fluids in 56 septic shock patients, at presentation and after 24 h of intravenous fluids in 100 sepsis patients, and in two groups of non-infected patients. We compared plasma heparan sulfate concentrations between sepsis and non-sepsis patients, as well as between sepsis survivors and sepsis non-survivors. We used multivariable linear regression to model the association between volume of intravenous fluids and changes in plasma heparan sulfate.. Consistent with previous studies, median plasma heparan sulfate was elevated in septic shock patients (118 [IQR, 113-341] ng/ml 6 h after presentation) compared to non-infected controls (61 [45-79] ng/ml), as well as in a second cohort of sepsis patients (283 [155-584] ng/ml) at emergency department presentation) compared to controls (177 [144-262] ng/ml). In the larger sepsis cohort, heparan sulfate predicted in-hospital mortality. In both cohorts, multivariable linear regression adjusting for age and severity of illness demonstrated a significant association between volume of intravenous fluids administered during resuscitation and plasma heparan sulfate. In the second cohort, independent of disease severity and age, each 1 l of intravenous fluids administered was associated with a 200 ng/ml increase in circulating heparan sulfate (p = 0.006) at 24 h after enrollment.. Glycocalyx degradation occurs in sepsis and septic shock and is associated with in-hospital mortality. The volume of intravenous fluids administered during sepsis resuscitation is independently associated with the degree of glycocalyx degradation. These findings suggest a potential mechanism by which intravenous fluid resuscitation strategies may induce iatrogenic endothelial injury.

Topics: Administration, Intravenous; Adult; Aged; Angiopoietin-2; Atrial Natriuretic Factor; Biomarkers; Endothelium; Female; Fluid Therapy; Glycocalyx; Heparitin Sulfate; Humans; Male; Mass Spectrometry; Middle Aged; Natriuretic Peptide, Brain; Resuscitation; Sepsis; Syndecan-1; Thrombomodulin; Tissue Plasminogen Activator; Vascular Endothelial Growth Factor Receptor-1

Topics: Hospitalization; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pneumonia; Sepsis

Topics: Aged; Emergency Service, Hospital; Hospitalization; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis

Topics: Hospitalization; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis

Topics: Follow-Up Studies; Humans; Natriuretic Peptide, Brain; Prognosis; Reproducibility of Results; Sepsis

While both sepsis-induced myocardial dysfunction (SIMD) and stress-induced cardiomyopathy (SICMP) are common in patients with sepsis, the pathogenesis of the 2 diseases is different, and they require different treatment strategies. Thus, we aimed to investigate risk factors and outcomes between the 2 diseases.This retrospective study enrolled patients diagnosed with sepsis or septic shock, admitted to intensive care unit via emergency department in Korea University Anam Hospital, and who underwent transthoracic echocardiography within the first 24 hours of admission.In all, 25 patients with SIMD and 27 patients with SICMP were enrolled. Chronic obstructive pulmonary disease and a history of heart failure (HF) were more prevalent in both the SIMD and SICMP groups than in the control group. In the SIMD and SICMP groups, levels of inflammatory cytokines were similar. Serum troponin level was significantly elevated in the SICMP and SIMD group compared to the control group. N-terminal pro-brain natriuretic peptide (NT pro-BNP) level was significantly elevated in the SIMD group compared to the SICMP group or control group. The in-hospital mortality rate in the SIMD and SICMP group was about 40%, showing increased trends compared with the control group. The in-hospital mortality rate was significantly increased in SIMD group with EF<30% than in SICMP group with EF<30%. In multiple logistic regression analysis, a past history of diabetes mellitus (DM) and HF was significantly associated with the incidence of SIMD. Younger age, elevated levels of NT pro-BNP, and positive result of blood culture also showed significant odds ratio regard to the occurrence of SIMD. However, only elevated lactate and troponin level were positively associated with the incidence of SICMP.The SIMD and SICMP had different risk factors. The risk factors of SIMD were younger age, history of DM, history of HF, elevated NT pro-BNP, and positive result of blood culture. The elevated levels of lactate and troponin were identified as risk factors of SICMP. More importantly, in-hospital mortality rate from SIMD and SICMP showed increased trend and worse outcome in SIMD group with reduced EF<30%. Thus, developing SIMD or SICMP reflected poor prognosis in sepsis or septic shock.

Topics: Age Factors; Aged; Aged, 80 and over; Biomarkers; Comorbidity; Cytokines; Diabetes Mellitus; Echocardiography; Female; Heart Failure; Hospital Mortality; Humans; Inflammation Mediators; Intensive Care Units; Lactic Acid; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Pulmonary Disease, Chronic Obstructive; Republic of Korea; Retrospective Studies; Risk Factors; Sepsis; Shock, Septic; Takotsubo Cardiomyopathy

To assess the predictive value of early phrase echocardiography and cardiac biomarkers in patients with severe sepsis.. A retrospective analysis of severe septic patients (patients with acute coronary syndrome and end stage renal disease were excluded) in department of intensive care unit of Capital Medical University Affiliated Beijing Shijitan Hospital from January 2013 to December 2017 was conducted. The acute physiology and chronic health evaluation II (APACHE II) score, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB) within 6 hours after admission, and bedside echocardiography indexes [left ventricular ejection fraction (LVEF), the ratio of the peak blood flow velocity in the early stage of the mitral valve and the peak blood flow rate of the mitral valve (E/A ratio)] within 6 hours after diagnosis were recorded. The differences of indexes between patients with decreased contractile function (LVEF < 0.50) group and normal group, and the difference between dead group and survival group within 28-day were compared. Receiver operating characteristic (ROC) curve and Logistic regression analysis were conducted to assess the early detected prognostic value in severe sepsis patients.. (1) A total of 316 patients were enrolled in the survey period. Decreased cardiac systolic function (LVEF < 0.50) was found in 89 cases (28.2%), and cardiac diastolic function impaired (E/A ratio < 1) in 269 cases (85.1%); while 79 cases (25.0%) had both systolic function and diastolic function impairment. (2) NT-proBNP and cTnI were statistically different between cardiac systolic function impaired group and normal group. Further Logistic regression analysis showed that only NT-proBNP was significantly correlated with LVEF [β=-1.311, odds ratio (OR) = 0.269, P < 0.001]. (3) Eighty-two of 316 cases were died in 28-day, and the 28-day mortality rate was 25.9%. Compared with the survival group, the ratio of E/A < 1, APACHE II score, NT-proBNP, cTnI, MYO, CK and CK-MB were significantly increased in death group. The ROC curve analysis showed that the above indexes had diagnosed value for prognosis in severe sepsis patient, among which NT-proBNP and cTnI had higher predictive value [the area under ROC curve (AUC) were 0.920 and 0.901 respectively, both P < 0.001]. Multivariate Logistic regression analysis showed that APACHE II score (β= 0.282, OR = 1.326, P < 0.001) and NT-proBNP (β= 0.402, OR = 1.261, P < 0.001) were independent risk factors for prognosis in patients with severe sepsis.. The LVEF values measured by echocardiography in early phrase were unrelated to 28-day prognosis. APACHE II score, E/A ratio, NT-proBNP, cTnI, MYO, CK and CK-MB were related to 28-day prognosis. APACHE II scores and NT-proBNP were independent prognostic factors in severe sepsis patient.

Topics: Biomarkers; Echocardiography; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Retrospective Studies; ROC Curve; Sepsis

N-terminal-probrain natriuretic peptide (NT-proBNP) is a marker of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. In this study, we assessed whether NT-proBNP levels could predict the risk of moderate to severe bronchopulmonary dysplasia (BPD) and/or death.. This was an observational prospective study of preterm infants with GA ≤32 weeks. Infants who died within the first 48 h or who had major congenital malformations or incomplete information were excluded. NT-proBNP was determined at 48-96 h of life and at 5-10 days of life. The predictive capacity of NT-proBNP for the combined outcome of BPD and/or death was evaluated using receiver operator characteristic (ROC) curves and multivariate regression.. Of the 125 eligible patients, 110 completed the analysis. Twenty-eight developed BPD (n = 15) and/or died (n = 13). Infants who developed BPD and/or died had higher NT-proBNP levels ​​at 48-96 h (26,848 ng/L, interquartile range [IQR] 7818-60,684 vs 3008 ng/L, IQR 1425-9876) and at 5-10 days (8849 ng/L, IQR 3796-19,526 vs 1427 ng/L, IQR 907-2889). The NT-proBNP levels at 5-10 days, but not at 48-96 h, were independently associated with BPD and/or death after adjustments for HsPDA and other confounders (OR = 3.36; 95%CI: 1.52-7.4, P = 0.006). For the prediction of this result, a cutoff of 3348 ng/L had a sensitivity and specificity of 82% and 83%, respectively (area under the curve [AUC] = 0.87; 95%CI: 0.79-0.95).. The NT-proBNP levels at 5-10 days of life may identify preterm infants with an HsPDA who are at high risk of BPD or death and may be useful for individualized preventive and therapeutic strategies.

Topics: Biomarkers; Bronchopulmonary Dysplasia; Enterocolitis, Necrotizing; Female; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intracranial Hemorrhages; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Respiratory Insufficiency; Sensitivity and Specificity; Sepsis

To estimate the value of combinative index (combination of routine biomarkers) for predicting 28-day mortality in patients with sepsis.. An observational study.. Department of Intensive Care Unit, the Second Hospital of Shandong University, Jinan, China, from August 2016 to December 2016.. Logistic regressions of biomarkers and a combination of biomarkers were performed to investigate risk factors for mortality in patients with sepsis. Several biomarkers were analysed in combination using receiver operating characteristic curves to evaluate the diagnostic performance of combinative index.. A total of 59 patients were enrolled; 13 were diagnosed as septic shock. The 28-day mortality rate was 22.0%. Univariate analysis revealed that nonsurvival patients were much older (p=0.022), with higher level of lactate (p=0.012), and with higher level of NT-proBNP (p=0.008) than survival patients. Multivariate logistic regression analysis identified arterial lactate (OR 8.62, 95% CI 1.07-71.43, p=0.043), NT-proBNP (OR 1.00, 95% CI 1.00-1.01, p=0.021), and CRP (OR 1.05, 95% CI 1.01-1.10, p=0.036) as independent predictors for 28-day mortality of septic patients. The combinative index (arterial lactate, NT-proBNP and CRP) displayed a better diagnostic performance than any single indicator (p=0.05, 0.02 and 0.02, respectively).. Combinative index (arterial lactate, NT-proBNP and CRP) could serve as a valuable predictor for the 28-day mortality rate in patients with sepsis.

Topics: Adult; Aged; Biomarkers; C-Reactive Protein; Female; Hospital Mortality; Humans; Intensive Care Units; Lactates; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pulmonary Artery; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Shock, Septic; Time Factors; Treatment Outcome

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

Sepsis is a multifactorial syndrome with increasing incidence of morbidity and mortality. Identification of outcome predictors is therefore essential. Recently, elevated brain natriuretic peptide (BNP) levels have been observed in patients with septic shock. Little information is available concerning BNP levels in patients with critical illness, especially with sepsis. Therefore, this study aims to evaluate the role of BNP as a biomarker for long-term mortality in patients with sepsis.. We studied 259 patients with sepsis and absence of heart failure. BNP levels were obtained for all patients. A long-term survival follow-up was done, and survival was evaluated 90days after admission, and during the subsequent 60months of follow-up.. Eighty-two patients died during the 90-day follow-up (31.7%), 53 died in the index hospitalization (20.5%). On multivariate analysis models, elevated values of BNP were a strong predictor of in-hospital mortality, 90-day and 60-month mortality in patients with sepsis. BNP was a better prognostic predictor than the Sepsis-related Organ Failure Assessment (SOFA) score for 90-day mortality, and a better predictor for 60-month mortality in low risk groups.. In the population of hospitalized patients with sepsis, BNP is a strong independent predictor of short- and long-term mortality.

Topics: Aged; Biomarkers; Critical Care; Female; Follow-Up Studies; Hospital Mortality; Humans; Male; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Prognosis; Sepsis; Shock, Septic

Cardiac biomarkers have been studied in sepsis in the past and various mechanisms for their rise have been elucidated. However their association with severity of sepsis, mortality and myocardial dysfunction warrants further studies. We have studied three different cardiac biomarkers- troponin T (trop T), creatine phosphokinase MB isoform (CPK MB) and NT pro brain natriuretic peptide (NT Pro BNP) in patients with septicemia. We have attempted to observe the levels of these biomarkers in sepsis, their individual abilities to predict the severity of sepsis, mortality and association with myocardial dysfunction noted in echocardiography.. There were 54 patients each of septicaemia and controls. The means of the three biomarkers, namely Troponin T, CPK MB and NT Pro BNP, were significantly elevated in patients with sepsis- mean values of 0.23±0.8 ng/ml, 9.9±13.4 ng/ml and 5988.62±13.7 pg/ml respectively. Myocardial dysfunction was observed in 27 cases. There were 13 non-survivors. Troponin T and NT pro BNP were strongly associated with higher mortality. CPK MB had better correlation with myocardial dysfunction.. We conclude that myocardial dysfunction using echocardiography is seen in around half of the patients with sepsis. Cardiac biomarkers can be routinely used in patients of septicemia to suggest the severity of sepsis,to detect myocardial injury and dysfunction and prognostication. CPK MB may be very useful to suspect myocardial dysfunction in such patients.

Topics: Biomarkers; Cardiomyopathies; Creatine Kinase, MB Form; Echocardiography; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Sepsis; Troponin T

Rapid and accurate prediction for sepsis remains a challenge in surgical intensive care units. Detection of individual biomarkers is often of marginal usefulness, and several biomarkers are difficult to measure in the clinical setting. The aim of this study was to evaluate the diagnostic and prognostic performance of three routine biomarkers, procalcitonin (PCT), B-type natriuretic peptide (BNP), and lymphocyte percentage, as individual or in combination for sepsis in surgical critically ill patients.. Circulating PCT, BNP, and lymphocyte percentage were measured in surgical patients on admission to the intensive care unit. A bioscore system combining these biomarkers was constructed. All studied variables were analyzed according to the diagnosis and clinical outcomes of sepsis.. A total of 320 consecutive patients were included in the analysis. One hundred fifty-six patients presented with sepsis. In the patients with sepsis, levels of PCT and BNP increased and lymphocyte percentage decreased. For individual biomarkers, PCT achieved the best area under the curve for the diagnosis of sepsis, whereas the diagnostic performance of the bioscore was better than that of each individual biomarker (area under the curve, 0.914 [95% confidence interval, 0.862-0.951]). Levels of BNP and bioscore increased in nonsurvivors in the entire cohort, but the accuracy of these two variables for mortality prediction was lower than that shown by Acute Physiology and Chronic Health Evaluation II score. Furthermore, bioscore failed to predict outcomes in septic patients.. A simple bioscore combining PCT together with BNP and lymphocyte percentage improves the diagnostic accuracy for sepsis in surgical critically ill patients but fails to predict outcomes in surgical patients with sepsis.

Topics: Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Decision Support Techniques; Female; Humans; Lymphocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Postoperative Complications; Prognosis; Prospective Studies; Protein Precursors; Sepsis

This clinical study investigated plasma NT-proBNP levels as a potential predictor of heart failure in pediatric patients with sepsis. Plasma NT-ProBNP levels of 211 pediatric patients with sepsis and 126 healthy children were measured. Patients were stratified as with heart failure (HF) or without heart failure (non-HF). Patients were graded as having sepsis, severe sepsis, or septic shock. The optimal cut-off values of plasma NT-ProBNP for heart failure were determined by analyzing the receiver operating characteristic (ROC). In the HF, non-HF and control groups, the median plasma NT-proBNP levels were 3640, 656, and 226 ng/L, respectively. For all patients with sepsis, the optimal diagnostic cut-off value was 1268 ng/L for differentiating heart failure. In the severe sepsis patients and septic shock patients, the optimal diagnostic cut-off values were 1368 ng/L and 1525 ng/L, respectively. This report is the first one to reveal that NT-proBNP may predict heart failure in children with sepsis. It provides an important clinical reference for the diagnosis of heart failure in pediatric patients with sepsis, and enables monitoring septic children for cardiac involvement.

Topics: Adolescent; Area Under Curve; C-Reactive Protein; Case-Control Studies; Child; Child, Preschool; Echocardiography; Heart Failure; Humans; Infant; Infant, Newborn; Natriuretic Peptide, Brain; Peptide Fragments; ROC Curve; Sepsis; Severity of Illness Index; Spectrometry, Fluorescence

The aim of this paper is to investigate whether urosepsis is related to irrigation pressure of ureteroscopy (URS) and evaluate the prognostic value of adrenomedullin (ADM) and atrial and brain natriuretic peptides (ANP and BNP) in URS-induced uroseptic patients. From July 2008 to October 2013, we enrolled 332 patients with untreated unilateral ureteral obstruction (UUO). The UUO group included three subgroups of, respectively, 118, 132, and 82 patients who underwent URS under intermittent stable irrigation pressure of, respectively, 80, 120, and 160 mmHg. The plasma concentrations of ADM, ANP, and BNP were measured in all subjects. URS was performed for all UUO patients; the values of the three peptides were measured again after URS. Irrigation pressure and stone size were independent risk factors of urosepsis. After URS, the plasma concentrations of ADM, ANP, and BNP were significantly higher in uroseptic patients. Moreover, the concentrations were significantly higher depending on the disease severity. Plasma concentrations of the three peptides were correlated with plasma ET concentration in the uroseptic patients. The areas under receiver operating characteristic (ROC) curve of ADM, ANP, and BNP for predicting urosepsis were 0.811, 0.728, and 0.764, respectively. In conclusion, ADM, along with ANP and BNP, is valuable for prognosis in urosepsis secondary to URS which is associated with irrigation pressure.

Topics: Adolescent; Adrenomedullin; Adult; Aged; Atrial Natriuretic Factor; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Sepsis; Ureteroscopy; Urinary Tract Infections; Young Adult

In the present study, the levels of NT-proBNP, troponin T, and troponin I were measured in postmortem serum from femoral blood in a series of sepsis-related fatalities that had undergone forensic autopsies. We aimed to assess whether a possible increase in the concentrations of these biomarkers was correlated to macroscopic or microscopic observations that suggest myocardial damage or cardiac dysfunction. Two study groups were retrospectively formed, a sepsis-related fatalities group and a control group. Both groups consisted of 16 forensic autopsy cases. Unenhanced computed tomography scan, autopsy, histological, toxicological, microbiological, and biochemical analyses were performed for all cases in both groups. Levels of procalcitonin, C-reactive protein, NT-proBNP, troponin T, and troponin I were systematically measured in postmortem serum from femoral blood. The preliminary results suggest that the postmortem serum troponin I, troponin T, and NT-proBNP levels are increased in sepsis-related deaths in the absence of any relevant coronary artery disease, myocardial ischemia, or signs of heart failure. These findings corroborate clinical data from previous studies pertaining to the usefulness of troponins and natriuretic peptides as indicators of toxic and inflammatory damage to the heart in cases of severe sepsis and septic shock without concomitant underlying coronary syndromes.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; C-Reactive Protein; Calcitonin; Case-Control Studies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Retrospective Studies; Sepsis; Troponin I; Troponin T

Sepsis lacks a reliable and readily available measure of disease activity. Thereby, it remains unclear how to monitor response to treatment. Research on numerous (new) biomarkers associated with sepsis provided disappointing results and little is known about changes in vital signs during sepsis resuscitation. We hypothesised that trends in vital signs together with routine biomarker levels during resuscitation might provide information about the response to treatment at a very early stage of sepsis in the emergency department (ED). We therefore explore trends in vital signs and routine biomarker levels during sepsis resuscitation in the ED.. Prospective observational pilot study.. ED of a tertiary care teaching hospital.. 99 Adult non-trauma patients with suspected infection and 2 or more systemic inflammatory response syndrome criteria admitted to the ED.. Vital signs and biomarker levels at admittance (T0) and after 3 h in the ED (T1).. In total, data of 99 patients were analysed. Of these patients, 63 presented with sepsis, 30 with severe sepsis and 6 with septic shock. All vital signs decreased, except for peripheral oxygen saturation which increased. Almost all routine biomarker levels decreased during resuscitation, except for C reactive protein, bands, potassium, troponin T and direct bilirubin which remained stable. Sodium, chloride and N-terminal prohormone of brain natriuretic peptide increased slightly.. Vital signs and biomarker levels showed descending trends during resuscitation, except for parameters directly affected by treatment modalities. Despite these trends, most patients improved clinically. Trends in vital signs and routine biomarkers might be helpful in predicting clinical course and response to treatment in patients with sepsis during early resuscitation.

Topics: Adult; Aged; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Bilirubin; Biomarkers; Blood Pressure; C-Reactive Protein; Chlorides; Comorbidity; Diuretics; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxygen; Peptide Fragments; Pilot Projects; Potassium; Prospective Studies; Resuscitation; Sepsis; Shock, Septic; Sodium; Troponin T; Vital Signs

This study aimed to evaluate the predictive and prognostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in patients with myocardial dysfunction induced by severe sepsis and septic shock.. A total of 84 patients with severe sepsis and septic shock were enrolled between May 2013 and December 2014.The patients were monitored by pulse indicator continuous cardiac output system and divided into myocardial depression group (cardiac function index [CFI] < 4.1/minute, n = 37) and nonmyocardial depression group (CFI ≥ 4.1/minute, n = 47 ). Additionally, the patients were divided into survival group (n = 40) and nonsurvival group (n = 44) based on 28-day mortality. Hemodynamic parameters and serum sTREM-1, B-type natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels were collected on days 1, 3 and 5 after admission to intensive care unit.. (1) The serum values of sTREM-1, BNP and cTnI in myocardial depression group were higher than those in nonmyocardial depression group (P < 0.01); and CFI, cardiac index, stroke volume, global ejection fraction and left ventricular contractility index (dpmax) in myocardial depression group were lower than those in nonmyocardial depression group on day 1 (P < 0.05); (2) serum sTREM-1 negatively correlated with left ventricular ejection fraction, CFI, cardiac index, global ejection fraction and dpmax, and it positively correlated with BNP and cTnI (P < 0.01); (3) the area under the receiver operating characteristics curve for sTREM-1 in the prediction of myocardial depression was 0.671 with a sensitivity of 83.8% and a specificity of 46.8% when cutoff point was 174.5ng/mL, the power of predicting septic depression for sTREM-1 was lower than that of BNP; logistic regression analysis showed that serum sTREM-1 was not an independent predictor of septic myocardial depression; the area under the receiver operating characteristics curve was 0.773 for sTREM-1 in predicting outcome with a sensitivity of 86.4% and a specificity of 80% when cutoff point was 182.3ng/mL, the power of predicting prognosis for sTREM-1 was superior to those of BNP and cTnI; (4) there was a decrease trend for sTREM-1 levels and an increasing trend for CFI in the survival group (P < 0.05).. Myocardial dysfunction is common in patients with severe sepsis and septic shock and high serum levels of sTREM-1 correlates with myocardial dysfunction to some extent but is not an independent predictor, which more importantly showed prognostic value for septic shock outcome.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Output; Cardiomyopathies; Echocardiography; Female; Heart; Humans; Male; Membrane Glycoproteins; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Receptors, Immunologic; ROC Curve; Sepsis; Shock, Septic; Stroke Volume; Triggering Receptor Expressed on Myeloid Cells-1; Troponin I

Excessive sympathetic stress has multiple adverse effects during critical illness including sepsis. Recent studies showed that heart rate control had a significant effect on reducing mortality in septic shock patients. Furthermore, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in septic patients were reportedly associated with adverse outcome. However, no study has evaluated the relationship between hemodynamic profiles of septic patients and the circulating cardiac biomarker. Our objective was to determine whether hemodynamic profiles, specifically tachycardia and new-onset atrial fibrillation (AF), were associated with NT-proBNP elevation in septic patients.. We consecutively enrolled patients admitted to our intensive care unit (ICU). NT-proBNP levels, heart rate, and rhythm at ICU admission were measured, and all clinical and laboratory data were prospectively collected. Tachycardia was defined as a heart rate of above 100 bpm.. Ninety-five patients out of 267 patients (35.6%) were diagnosed as sepsis. Of these septic patients, 47 presented with tachycardia and 6 developed new-onset AF. Multivariate Cox regression analysis revealed that tachycardia was an independent predictor of 28-day overall survival in septic patients (hazard ratio, 4.22; 95% confidence interval, 1.10-27.72; P < 0.05), but not in nonseptic patients. Multivariate linear regression analysis demonstrated that the presence of tachycardia was an independent determinant of NT-proBNP elevation (P < 0.05) in septic patients, but not in nonseptic patients.. Tachycardia was significantly and independently associated with NT-proBNP elevation and lower survival rate in septic patients, although no association was observed in nonseptic patients. Increased NT-proBNP in sepsis with tachycardia might predict poor outcomes in ICU.

Topics: Adult; Aged; Atrial Fibrillation; Female; Heart Rate; Hemodynamics; Humans; Kaplan-Meier Estimate; Linear Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sepsis; Tachycardia

Secretoneurin is produced in neuroendocrine cells, and the myocardium and circulating secretoneurin levels provide incremental prognostic information to established risk indices in cardiovascular disease. As myocardial dysfunction contributes to poor outcome in critically ill patients, we wanted to assess the prognostic value of secretoneurin in two cohorts of critically ill patients with infections.. Two prospective, observational studies.. Twenty-four and twenty-five ICUs in Finland.. A total of 232 patients with severe sepsis (cohort #1) and 94 patients with infections and respiratory failure (cohort #2).. None.. We measured secretoneurin levels by radioimmunoassay in samples obtained early after ICU admission and compared secretoneurin with other risk indices. In patients with severe sepsis, admission secretoneurin levels (logarithmically transformed) were associated with hospital mortality (odds ratio, 3.17 [95% CI, 1.12-9.00]; p = 0.030) and shock during the hospitalization (odds ratio, 2.17 [1.06-4.46]; p = 0.034) in analyses that adjusted for other risk factors available on ICU admission. Adding secretoneurin levels to age, which was also associated with hospital mortality in the multivariate model, improved the risk prediction as assessed by the category-free net reclassification index: 0.35 (95% CI, 0.06-0.64) (p = 0.02). In contrast, N-terminal pro-B-type natriuretic peptide levels were not associated with mortality in the multivariate model that included secretoneurin measurements, and N-terminal pro-B-type natriuretic peptide did not improve patient classification on top of age. Secretoneurin levels were also associated with hospital mortality after adjusting for other risk factors and improved patient classification in cohort #2. In both cohorts, the optimal cutoff for secretoneurin levels at ICU admission to predict hospital mortality was ≈ 175 pmol/L, and higher levels were associated with mortality also when adjusting for Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores.. Secretoneurin levels provide incremental information to established risk indices for the prediction of mortality and shock in critically ill patients with severe infections.

Topics: Age Factors; Aged; Body Mass Index; Comorbidity; Critical Illness; Female; Finland; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Neuropeptides; Organ Dysfunction Scores; Pneumonia; Prognosis; Prospective Studies; Risk Factors; Secretogranin II; Sepsis; Sex Factors

In meta-analyses of diagnostic test accuracy, routinely only one pair of sensitivity and specificity per study is used. However, for tests based on a biomarker or a questionnaire often more than one threshold and the corresponding values of true positives, true negatives, false positives and false negatives are known.. We present a new meta-analysis approach using this additional information. It is based on the idea of estimating the distribution functions of the underlying biomarker or questionnaire within the non-diseased and diseased individuals. Assuming a normal or logistic distribution, we estimate the distribution parameters in both groups applying a linear mixed effects model to the transformed data. The model accounts for across-study heterogeneity and dependence of sensitivity and specificity. In addition, a simulation study is presented.. We obtain a summary receiver operating characteristic (SROC) curve as well as the pooled sensitivity and specificity at every specific threshold. Furthermore, the determination of an optimal threshold across studies is possible through maximization of the Youden index. We demonstrate our approach using two meta-analyses of B type natriuretic peptide in heart failure and procalcitonin as a marker for sepsis.. Our approach uses all the available information and results in an estimation not only of the performance of the biomarker but also of the threshold at which the optimal performance can be expected.

Topics: Biomarkers; Calcitonin; Heart Failure; Humans; Linear Models; Meta-Analysis as Topic; Natriuretic Peptide, Brain; Normal Distribution; Reproducibility of Results; ROC Curve; Sepsis

Using biomarkers to predict mortality in patient with severe sepsis or septic shock is of importance, as these patients frequently have high mortality and unsatisfied outcome. N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) play extremely important roles in prognostic value in the mortality of severe sepsis and septic shock.. The present study was retrospectively designed to evaluate the predicting mortality of NT-proBNP and cTnI in elderly patients with severe sepsis or septic shock administered in the intensive care unit (ICU) and also to evaluate whether the predicting ability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score or C-reactive protein (CRP) was increased in combination with the biomarkers.. A cohort of 430 patients (aged ≥65 years) with severe sepsis or septic shock admitted to our ICU between October 2011 and December 2013 was included in the study. Patient data including clinical, laboratory, and survival and mortality were collected. All patients were examined with NT-proBNP, cTnI, CRP, and APACHE-II score and were categorized as the survived and deceased groups according to the outcome 30 days after ICU treatment.. The levels of NT-proBNP and cTnI (P < .01) or CRP (P < .05) were significantly higher in the deceased group than those in the survived group. The predicting mortality of APACHE-II score alone was low but largely improved, when it was combined with both NT-proBNP and cTnI (P < .05).. The alteration of NT-proBNP and cTnI levels strongly predicated the ICU prognosis in elderly patients with severe sepsis or septic shock. N-terminal pro-brain natriuretic peptide and cTnI were superior to CRP in predicting mortality. The predicting ability of APACHE-II score was improved only when combined with NT-proBNP and cTnI.

Topics: Aged; Aged, 80 and over; APACHE; Biomarkers; C-Reactive Protein; Cohort Studies; Female; Humans; Intensive Care Units; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Retrospective Studies; Sepsis; Shock, Septic; Troponin I

Topics: Burns; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Sepsis

Topics: Burns; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Sepsis

To investigate the impacts of sepsis-induced cardiac dysfunction on hemodynamics, organ function and prognosis in the patients with septic shock.. A prospective cohort study was conducted in 44 patients suffering from septic shock with the duration < 24 hours admitted to the Department of Critical Care Medicine of Peking University Third Hospital during June 2013 to June 2014. The patients were divided into two groups according to the left ventricular ejection fraction (LVEF) as recorded in echocardiogram at time of admission to the intensive care unit (ICU) as sepsis-induced myocardial dysfunction group (LVEF < 0.50, n = 11) and normal cardiac function group (LVEF ≥ 0.50, n = 33). The cardiac function evaluation and hemodynamics monitoring were performed with echocardiogram and pulse-induced contour cardiac output (PiCCO) on 1, 3, 7 days after the ICU admission. The plasma levels of the biomarkers of myocardial damage, troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured, and the parameters representing organ function and the 28-day prognosis were collected as well.. On the ICU admission, central venous pressure (CVP) and left ventricular end-diastolic diameter (LVEDD) were obviously lower in normal cardiac function group than those of myocardial dysfunction group [CVP (mmHg, 1 mmHg = 0.133 kPa): 10 ± 4 vs. 14 ± 6, P < 0.05; LVEDD (mm): 45.0 ± 5.3 vs. 51.8 ± 7.1, P < 0.01], and there was no significant difference in other hemodynamic parameters between two groups. On the 3rd day, all the cardiac function and hemodynamic parameters showed no significant differences between the two groups. On the 7th day, the cardiac index (CI) and pulmonary vascular permeability index (PVPI) of normal cardiac function group were significantly higher than those of myocardial dysfunction group [CI (mL×s⁻¹×m⁻²): 63.3 ± 13.3 vs. 48.3 ± 10.0, P <0.05; PVPI: 1.5 (1.4, 1.9) vs. 1.1 (0.7, 1.1), P < 0.01], and no significant difference was found in the other parameters. The plasma levels of TnT and NT-proBNP were found to have no difference at three time points between two groups. There was no difference in the number or the extent of organ dysfunction, including lung, kidney, liver and coagulation system, between the groups at the time of ICU admission. There was no obvious difference in the 28-day survival rate between the myocardial dysfunction group and normal cardiac function group [81.8% (9/11) vs. 72.7% (24/33), χ² = 0.398, P = 0.528].. Sepsis-induced myocardial dysfunction is a reversible organ dysfunction. It can directly induce decreased left ventricular systolic function and enlargement of ventricle in patients with septic shock without reducing cardiac output or impairing the functions of other organs, or elevating the mortality rate.

Topics: Capillary Permeability; Cardiac Output; Central Venous Pressure; Cohort Studies; Echocardiography; Heart; Hemodynamics; Humans; Intensive Care Units; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Sepsis; Shock, Septic

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.. 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.. 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.. 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.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Biomarkers; Critical Illness; Female; Fluid Therapy; Humans; Intensive Care Units; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Sepsis; Taiwan; Treatment Outcome

To study the value of Pentraxin 3 (PTX3) in diagnosing the severity and cardiovascular function of the critically ill children. Method A total of 178 patients who were older than 28 days, with acute infection of respiratory or neurological system, excluding chronic or special disease, and admitted to the pediatric intensive care unit (PICU) of Hunan Children's Hospital from October 1, 2013 to April 30, 2014 were enrolled, including 102 male cases and 76 female cases. The ages ranged from 1 month to 13 years and 1 month, 78 of them were less than 1 year old ; 58 cases were between 1 to 3 years old; 42 cases were above 3 years old; 101 cases were diagnosed as respiratory system diseases, 77 cases had nervous system diseases. PTX3 was detected with enzyme-linked immunosorbent assay (ELISA) within 1 d after enrollment, at 3 days and 7 days, meanwhile, troponin, myocardial enzyme, brain-type natriuretic peptide (BNP), C-reactive protein (CRP), plasma calcitonin (PCT) and WBC etc. Were measured. According to the plasma PTX3 value which were measured within 24 h after enrollment the patients were divided into three groups: mildly elevated group (< 44 µg/L) 41 cases; moderately elevated group (44 - < 132 µg/L) in 66 cases; severely elevated group 71 cases (132 µg/L or higher). Those 178 patients were divided into 3 groups according to the degree of infection: non-sepsis group (78 cases), sepsis group (70 cases), severe sepsis group (30 cases), and in each group, those with heart failure were respectively 19 cases, 28 cases, 17 cases. Analysis of the plasma PTX3 expression changes in different clinical manifestations, different condition, different degrees of organ damages and prognosis for the patient. The continuous variables were analyzed with t-test, F-test, H-test, the categorical variables were analyzed with Chi-square test, and the correlation analysis was performed to calculate Pearson coefficients.. The PTX3 value measured within 24 h after enrollment increased with the degree of infection (50. 4(35. 2,70. 4) µg/L; 175. 8 (99. 6, 309. 9) µg/L;419. 9 (168. 3, 468. 6) µg/L; H = 88. 345, P = 0. 000). PTX3 level gradually declined, while in severe sepsis group decreased slowly (P <0. 05); the area under the ROC curve of Plasma PTX3 was larger than that of other inflammatory markers such as CRP and PCT, white blood cells and neutrophils in the diagnosis of sepsis; while the former three are PTX3, PCT and CRP (the sensitivity and specificity respectively were 0. 77, 0. 68; 0. 66, 0. 6; 0. 47, 0. 55); the PTX3 value of the severely elevated group was significantly higher than those of the mildly and moderately elevated groups (P <0. 05). The proportion of having 3 or more organs failure increased as the PTX3 rising among the groups of mildly elevated group, moderately elevated group and severely elevated group (1(2. 4%), 4(6. 1%), 14(19. 7%) χ2 =16. 16,P = 0. 000); and in each group, the proportion of having good and poor prognosis for these three groups were different (33 (80.5%) and 8 (19. 5%), 35 (53%) and 31 (47%), 28 (39.4%) and 43 (60.6%), χ = 17. 663, P = 0. 000). The K-M curve for these three groups had statistically significant difference (χ2 = 7. 086, P = 0. 029). Those with heart failure had higher PTX3 value than those in non-heart failure at the same degree of infection. PTX3 value increased with myocardial enzyme (troponin, creatine kinase isoenzyme, BNP) levels. In the diagnosis of heart failure, the area under the ROC curve were respectively PTX3 0. 824; BNP 0. 772; CM-KB 0. 643; CNTIO. 671, the sensitivity and specificity were PTX3 0. 8, 0. 58; CK-MB 0. 56,0. 79; CTNI 0. 60,0. 69; BNP 0. 73, 0. 58. In terms of predicting the prognosis of sepsis with heart failure complications, the PTX3 value's area under ROC curve was larger than that of BNP (respectively 0. 844, 0. 472).. The PTX3 is an objective biochemical marker in diagnosis of sepsis; it is helpful in assessment of severity and prognosis of sepsis; it also has a certain clinical value in the assessment of sepsis cardiovascular function damage.

Topics: Adolescent; Biomarkers; C-Reactive Protein; Calcitonin; Cardiovascular System; Child; Child, Preschool; Creatine Kinase; Enzyme-Linked Immunosorbent Assay; Female; Humans; Infant; Intensive Care Units, Pediatric; Leukocyte Count; Male; Natriuretic Peptide, Brain; Prognosis; Protein Precursors; ROC Curve; Sensitivity and Specificity; Sepsis; Serum Amyloid P-Component; Troponin

Sepsis is the leading cause of death in the intensive care units worldwide. Proinflammatory cytokines such as TNF (tumor necrosis factor)-α and IL (interleukin)-6 mediate the pathogenesis of septic shock characterized by hemodynamic instability and end-stage multi-organ functional failure. Brain natriuretic peptide (BNP) has been used as a diagnostic and prognostic biomarker in the cardiovascular disorders. Most recently, plasma level of BNP has also been used to predict outcomes of critical illnesses including sepsis. We have recently reported that human recombinant BNP (rhBNP) could protect lungs from acute proinflammatory injury in response to LPS-injection. In the current study, using LPS (lipopolysaccharide)-induced canine sepsis models, we further investigated the effect of rhBNP on intestinal injury and its potential mechanisms. We have found that rhBNP (5μg or 10μg/kg weight) could significantly reduce intestinal tissue damage in response to LPS-injection in the dog sepsis models through down-regulating proinflammatory cytokines TNF-α and IL-6 (5-10 fold decrease compared to LPS-injection only group) by a mechanism of suppressing IκB phosphorylation and NF-κB expression. These findings suggest that BNP protect intestinal tissues from endotoxin-induced hyper-inflammatory injury and thus, may be used as therapeutic agents for sepsis.

Topics: Animals; Anti-Inflammatory Agents; Disease Models, Animal; Dogs; Humans; I-kappa B Proteins; Interleukin-6; Jejunum; Lipopolysaccharides; Natriuretic Peptide, Brain; NF-kappa B; Recombinant Proteins; Sepsis; Tumor Necrosis Factor-alpha

To investigate the prognostic significance of serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), procalcitonin (PCT), N-terminal probrain natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), cytokines, and clinical severity scores in patients with sepsis.. A total of 102 patients with sepsis were divided into survival group (n = 60) and nonsurvival group (n = 42) based on 28-day mortality. Serum levels of biomarkers and cytokines were measured on days 1, 3, and 5 after admission to an ICU, meanwhile the acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated.. Serum sTREM-1, PCT, and IL-6 levels of patients in the nonsurvival group were significantly higher than those in the survival group on day 1 (P < 0.01). The area under a ROC curve for the prediction of 28 day mortality was 0.792 for PCT, 0.856 for sTREM-1, 0.953 for SOFA score, and 0.923 for APACHE II score. Multivariate logistic analysis showed that serum baseline sTREM-1 PCT levels and SOFA score were the independent predictors of 28-day mortality. Serum PCT, sTREM-1, and IL-6 levels showed a decrease trend over time in the survival group (P < 0.05). Serum NT-pro-BNP levels showed the predictive utility from days 3 and 5 (P < 0.05).. In summary, elevated serum sTREM-1 and PCT levels provide superior prognostic accuracy to other biomarkers. Combination of serum sTREM-1 and PCT levels and SOFA score can offer the best powerful prognostic utility for sepsis mortality.

Topics: Adult; Aged; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intensive Care Units; Interleukin-6; Male; Membrane Glycoproteins; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Receptors, Immunologic; ROC Curve; Sepsis; Time Factors; Treatment Outcome; Triggering Receptor Expressed on Myeloid Cells-1

We investigated the diagnostic and prognostic utilities of procalcitonin (PCT), B-type natriuretic peptide (BNP), and neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with suspected sepsis, for whom sepsis was diagnosed clinically or based on PCT concentrations.. PCT, BNP, and NGAL concentrations were measured in 340 patients and were followed up in 109 patients. All studied biomarkers were analyzed according to the diagnosis, severity, and clinical outcomes of sepsis.. Clinical sepsis and PCT-based sepsis showed poor agreement (kappa = 0.2475). BNP and NGAL showed significant differences between the two groups of PCT-based sepsis (P = 0.0001 and P < 0.0001), although there was no difference between the two groups of clinical sepsis. BNP and NGAL were significantly different according to the PCT staging and sepsis-related organ failure assessment subscores (P < 0.0001, all). BNP and PCT concentrations were significantly higher in the non-survivors than in the survivors (P = 0.0002) and showed an equal ability to predict in-hospital mortality (P = 0.0001). In the survivors, the follow-up NGAL and PCT concentrations were significantly lower than the initial values (148.7 ng/mL vs. 214.5 ng/mL, P < 0.0001; 0.61 ng/mL vs. 5.56 ng/mL, P = 0.0012).. PCT-based sepsis diagnosis seems to be more reliable and discriminating than clinical sepsis diagnosis. Multimarker approach using PCT, BNP, and NGAL would be useful for the diagnosis, staging, and prognosis prediction in the critically ill patients with suspected sepsis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Critical Illness; Female; Humans; Infant; Infant, Newborn; Lipocalins; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Protein Precursors; Sepsis

Accurate diagnosis of sepsis is difficult in patients post burn due to the large inflammatory response produced by the major insult. We aimed to estimate the values of serum N-terminal pro-B-type natriuretic peptide and procalcitonin and the changes in hemodynamic variables as markers of sepsis in critically ill burn patients.. Prospective, observational study.. A quaternary-level university-affiliated ICU.. Fifty-four patients with burns to total body surface area of greater than or equal to 15%, intubated with no previous cardiovascular comorbidities, were enrolled.. At admission, a FloTrac/Vigileo system was attached and daily blood samples taken from the arterial catheter. Infection surveillance was carried out daily with patients classified as septic/nonseptic according to American Burns Consensus criteria.. N-terminal pro-B-type natriuretic peptide, procalcitonin, and waveform analysis of changes in stroke volume index and systemic vascular resistance index were measured within the first 24 hours after burn and daily thereafter for the length of the ICU stay or until their first episode of sepsis. Prevalences of stroke volume variation less than 12% (normovolemia) with hypotension (systolic blood pressure < 90 mm Hg) were recorded. Patients with sepsis differed significantly from "no sepsis" for N-terminal pro-B-type natriuretic peptide, systemic vascular resistance index, and stroke volume index on days 3-7. Procalcitonin did not differ between sepsis and "no sepsis" except for day 3. Area under the receiver operating characteristic curves showed excellent discriminative power for B-type natriuretic peptide (p = 0.001; 95% CI, 0.99-1.00), systemic vascular resistance index (p < 0.001; 95% CI, 0.97-0.99), and stroke volume index (p < 0.01; 95% CI, 0.96-0.99) in predicting sepsis but not for procalcitonin (not significant; 95% CI, 0.29-0.46). A chi-square crosstab found that there was no relationship between hypotension with normovolemia (stroke volume variation < 12%) and sepsis.. Serum N-terminal pro-B-type natriuretic peptide levels and certain hemodynamic changes can be used as an early indicator of sepsis in patients with burn injury. Procalcitonin did not assist in the early diagnosis of sepsis.

Topics: Adolescent; Adult; Biomarkers; Burns; Calcitonin; Calcitonin Gene-Related Peptide; Critical Illness; Female; Hemodynamics; Hospital Mortality; Hospitals, University; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Sepsis; Young Adult

To explore the diagnostic value of transthoracic echocardiogram (TTE) and/or plasma B-type natriuretic peptide (BNP) for left ventricular (LV) systolic dysfunction and/or LV diastolic dysfunction in septic patients.. In this prospective observational study, 90 septic patients and 30 non-septic ones underwent serial TTEs to measure LV ejection fraction (LVEF) and blood flow velocity of mitral annulus during early diastole (E) and atrial contraction (A) ratio (E/A) within 24 h of admission, 2, 3, 5 and 7 days. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of BNP simultaneously. Patient medical records were used to obtain the information of demographics, APACHE II scores and 28-day survival rates.. LVEF and E/A decreased significantly more in sepsis group (P = 0.00) while BNP elevated in sepsis group (P = 0.00). LVEF and E/A showed an initial drop and a subsequent rise. On the contrary, BNP increased and then decreased. There was a positive correlation between LVEF and E/A (r = 0.670, P = 0.00) while BNP level had a negative correlation with LVEF and E/A (r₁ = -0.733, P₁ = 0.00; r₂ = -0.929, P₂ = 0.00). Receiver operating characteristic (ROC) curve analysis showed that a cutoff point of BNP at 536.3 ng/L for diagnosing sepsis-induced LV systolic dysfunction had a sensitivity of 84.4% and a specificity of 68.7%. When at 505.0 ng/L, the valves were 56.0% and 97.4% respectively.. TTE may uncover septic patients whose LV diastolic dysfunction occurs earlier and reverses later than systolic type. And it may also participate in systolic dysfunction. The levels of BNP, probably as an adjustment to LV function, are more closely aligned with the severity of septic LV diastolic dysfunction. The combined application of TTE and plasma BNP appears to be efficacious for dynamically assessing cardiac function in septic patients.

Topics: Adult; Aged; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Sepsis; Ventricular Dysfunction, Left

Elevated plasma B-type natriuretic peptide (BNP) levels in patients with critical sepsis (severe sepsis and septic shock) may indicate septic cardiomyopathy. However, multiple heterogeneous conditions may also be involved in increased BNP level. In addition, the prognostic value of BNP in sepsis remains debatable. In this study, we sought to discover potential independent determinants of BNP elevation in critical sepsis. The prognostic value of BNP was also evaluated.. In this observational study, we enrolled mechanically ventilated, critically septic patients requiring hemodynamic monitoring through a pulmonary artery catheter. All clinical, laboratory and survival data were prospectively collected. Plasma BNP concentrations were measured daily for five consecutive days. Septic cardiomyopathy was assessed on day 1 on the basis of left and right ventricular ejection fractions (EF) derived from echocardiography and thermodilution, respectively. Mortality was recorded at day 28.. A total of 42 patients with severe sepsis (N = 12) and septic shock (N = 30) were ultimately enrolled. Daily BNP levels were significantly elevated in septic shock patients compared with those with severe sepsis (P ≤0.002). Critical illness severity (assessed by Acute Physiology and Chronic Health Evaluation II and maximum Sequential Organ Failure Assessment scores), and peak noradrenaline dose on day 1 were independent determinants of BNP elevation (P <0.05). Biventricular EFs were inversely correlated with longitudinal BNP measurements (P <0.05), but not independently. Pulmonary capillary wedge pressures (PCWP) and volume expansion showed no correlation with BNP. In septic shock, increased central venous pressure (CVP) and CVP/PCWP ratio were independently associated with early BNP values (P <0.05).. The severity of critical illness, rather than septic cardiomyopathy, is probably the major determinant of BNP elevation in patients with critical sepsis. Daily BNP values are of limited prognostic value in predicting 28-day mortality; however, fast BNP decline over time and a decrease in BNP <500 pg/ml may imply a favorable outcome.

Topics: Adult; Biomarkers; Cardiomyopathies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Sepsis; Survival Analysis

The objective of this study was to evaluate the protective effect of recombinant human brain natriuretic peptide (rhBNP) on endotoxin-induced acute kidney injury (AKI) in canine model of septic shock and its potential mechanisms. Dogs with endotoxin-induced septic shock were subjected to intravenous infusion of saline solution or rhBNP at the concentrations of 5 μg/kg (low-dose intervention group) or 10 μg/kg (high-dose intervention group). At 0, 2, 4, 8, and 12 h, the systemic vascular resistance index (SVRI) as well as serum levels of high mobility group box 1 protein (HMGB-1) and creatinine were measured, and kidney tissue samples were taken for histological examination. We have found that low and high doses of rhBNP could significantly reduce kidney tissue damage, such as tubular epithelial swelling and atrophy, and interstitial cell swelling in response to LPS injection in the dog sepsis models. rhBNP administration significantly reduced SVRI and serum levels of creatinine in dogs with LPS-induced sepsis in a dose-dependent manner, and attenuated the rise in the circulating HMGB-1. In conclusion, these findings suggest that rhBNP may exert dose-dependent protective effect on kidney tissue with endotoxin-induced injury, and this effect may be associated with the changes in blood levels of HMGB-1. rhBNP may be considered as therapeutic agents for treating sepsis-induced AKI.

Topics: Acute Kidney Injury; Animals; Creatinine; Dogs; Dose-Response Relationship, Drug; Female; HMGB1 Protein; Humans; Kidney; Lipopolysaccharides; Male; Natriuretic Peptide, Brain; Recombinant Proteins; Sepsis; Vascular Resistance

Since its introduction to the intensive care setting a decade ago, B-type natriuretic peptide has been the focus of studies in different areas (in particular, sepsis). With this biomarker, as with many newly identified biomarkers, its diagnostic performance was pursued initially and then its ability to predict outcomes. Despite all the efforts, results have not been consistent and the applications of B-type natriuretic peptide in the intensive care setting remain by and large academic. Will such studies one day become clinical practice? Or are we too obsessed with finding a place for every biomarker?

Topics: Biomarkers; Humans; Intensive Care Units; Natriuretic Peptide, Brain; Prognosis; Sepsis

Topics: Burns; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Sepsis

Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Critical Illness; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Sepsis; Ventricular Function, Left; Young Adult

This study aimed to determine the predictive value of elevated N-terminal pro-brain natriuretic peptide (NTproBNP) for mortality in patients with severe sepsis.. This was a retrospective study in Emergency Department of Sichuan Provincial People's Hospital, and patients were screened between January 1, 2009 and December 31, 2011. Demographic and clinical data as well as Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sepsis Organ Failure Assessment (SOFA) scores were collected within the first day of admission. Survival was determined to establish its association with the NT-proBNP using logistic regression and receiver operating characteristic (ROC) curve.. A total of 171 patients with severe sepsis were analyzed. The median APACHE IIⅡ and SOFA scores were 11 (IQR, 7-16) and 3 (IQR, 1-5), respectively. The median C-reactive protein (CRP), procalcitonin (PCT) and NT-proBNP was 10.3 mg/dL (IQR, 3.4-21.4 mg/dL), 0.4 ng/mL (IQR, 0.2-3.6 ng/mL), and 954 (321-1576) pg/mL, respectively. The median NT-proBNP in survivors was 584 pg/mL (IQR, 321-875 pg/mL) versus 1271 (IQR, 851-1576 pg/mL) in nonsurvivors (p < 0.001). In the ROC curves, the area value was 0.89 for serum NT-proBNP, and its potent cutoff value was 1500 pg/mL. After multivariate regression analysis, NT-proBNP was significantly correlated with the mortality of severe sepsis (OR = 1.58, 95% CI 1.36-1.77).. Serum NT-proBNP is frequently increased in severe sepsis patients, and non-survivors have higher levels than survivors. High levels of admission NT-proBNP are associated with mortality.

Topics: Biomarkers; China; Female; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Retrospective Studies; Sepsis; Severity of Illness Index; Survival Analysis

To investigate the association of serum sTREM-1 with myocardial dysfunction in patients with severe sepsis.. A total of 85 patients with severe sepsis were divided into severe sepsis group (n = 40) and septic shock group (n = 45). Serum levels of sTREM-1, NT-proBNP, APACHE II score, SOFA score, cardiac index, cardiac function index, global ejection fraction, and left ventricular contractility index were measured on days 1, 3, and 7 after admission to ICU.. Serum sTREM-1 levels of patients with septic shock were significantly higher than those with severe sepsis on days 1, 3, and 7. Serum sTREM-1 was positively correlated with APACHE II scores, SOFA scores, and NT-proBNP. However, The sTREM-1 level was markedly negatively correlated with CI, CFI, GEF, and dP/dt max, respectively. Multiple logistic regression analysis showed that sTREM-1 was independent risk factor to NT-proBNP increasing. The optimal cut-off point of sTREM-1 for detecting patients with myocardial dysfunction was 468.05 ng/mL with sensitivity (80.6%) and specificity (75.7%). There is no difference in TREM-1-mRNA expression between the two groups.. Serum sTREM-1 is significantly associated with myocardial dysfunction and may be a valuable tool for determining the presence of myocardial dysfunction in patients with severe sepsis.

Topics: Aged; Cardiomyopathies; Female; Heart Ventricles; Humans; Male; Membrane Glycoproteins; Middle Aged; Myeloid Cells; Myocardium; Natriuretic Peptide, Brain; Peptide Fragments; Receptors, Immunologic; Regression Analysis; RNA, Messenger; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Shock, Septic; Triggering Receptor Expressed on Myeloid Cells-1

Mycoplasma pneumonia is responsible for multisystemic infection. Pulmonary symptoms are most common in children. We describe herein two unusual severe forms of M. pneumoniae infection without initial pulmonary symptoms. The first case is an 8-month-old boy who was hospitalized in the pediatric intensive care unit with severe sepsis. There were no initial pulmonary symptoms, nor obvious clinical infection. Initial blood tests and x-ray did not aid the diagnosis. The blood tests came back positive for M. pneumonia. Pulmonary symptoms eventually appeared 24h later, and there was a pneumonia outbreak on the chest radiograph. The boy was given josamycin and improved quickly. The second case concerns an 8-year-old child who was hospitalized in the pediatric intensive care unit with toxic shock. No clinical infectious origin was found. A broad-spectrum antibiotic therapy was started with ceftriaxone and josamycin. The M. pneumoniae blood test came back positive, which confirmed the diagnosis of septic shock in M. pneumoniae, requiring adjustment of the antibiotic therapy. Current guidelines for the choice of probabilistic antibiotic therapy in case of severe sepsis do not include the case of M. pneumoniae. The early initiation of antibiotic therapy plays a major role in the prognosis of these patients. It seems useful to search for M. pneumoniae in cases of severe atypical infections, particularly in the absence of pulmonary symptoms.

Topics: Anti-Bacterial Agents; Ceftriaxone; Erythema; Female; Fever; Humans; Infant; Josamycin; Male; Mycoplasma pneumoniae; Natriuretic Peptide, Brain; Pneumonia, Mycoplasma; Sepsis; Severity of Illness Index; Tachycardia

To evaluate plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels as a marker of cardiac function during severe sepsis and septic shock.. A prospective study was conducted, and 44 patients without history of heart diseases but suffering from severe sepsis and septic shock underwent the transesophageal echocardiography (TEE) to obtain data about left and right ventricular function on 1, 3, 7 days in intensive care unit (ICU). At the same time, blood samples were collected to measure the levels of plasma NT-proBNP, quality of creatine kinase isoenzyme (CK-MBmass), troponin T (cTnT) and lactate. The factors affecting plasma NT-proBNP levels in patients with severe sepsis and septic shock were analyzed, and correlation between NT-proBNP and cardiac function indexes were evaluated.. Of 44 patient with severe sepsis and septic shock, 21 cases died in 28 days, with the mortality rate of 47.73%. The plasma NT-proBNP values on 1, 3, 7 days in ICU of 21 non-survivors were obviously higher than those of 23 survivors [10 112 (855-35 000) ng/L vs. 4 116 (185-28 437)ng/L, Z=-2.622, P=0.009; 13 811 (1 127-35 000) ng/L vs. 899 (116-35 000)ng/L, Z=-3.459, P=0.000; 6 786 (398-35 000) ng/L vs. 623 (98-4 118)ng/L, Z=-3.001, P=0.003]. Non-conditional logistic regression analysis and linear regression analysis, plasma lactate (t=2.420, P=0.020) and acute physiology and chronic health evaluation system II (APACHEII) score (t=3.482, P=0.001) on day 1, and left ventricular ejection fraction (LVEF, t=-2.326, P=0.029) on day 7 showed that they were independent affecting factors for plasma NT-proBNP levels. Patients were subdivided into two groups based on LVEF. It was found that the plasma NT-proBNP values in abnormal group (LVEF<0.50, n=8) were significantly higher than those in normal group (LVEF≥0.50, n=17) on day 7 [1 231 (398-5 000) ng/L vs. 513 (98-10 047) ng/L, Z=-1.831, P=0.047].. Plasma NT-proBNP levels on day 7 in ICU could reflect the left ventricular systolic dysfunction in patients with severe sepsis and septic shock.

Topics: Adult; Aged; Aged, 80 and over; APACHE; Echocardiography, Transesophageal; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Plasma; Prospective Studies; Sepsis; Shock, Septic; Ventricular Dysfunction, Left

Systolic dysfunction in septic shock is well recognized and, paradoxically, predicts better outcome. In contrast, diastolic dysfunction is often ignored and its role in determining early mortality from sepsis has not been adequately investigated.. A cohort of 262 intensive care unit patients with severe sepsis or septic shock underwent two echocardiography examinations early in the course of their disease. All clinical, laboratory, and survival data were prospectively collected. Ninety-five (36%) patients died in the hospital. Reduced mitral annular e'-wave was the strongest predictor of mortality, even after adjusting for the APACHE-II score, low urine output, low left ventricular stroke volume index, and lowest oxygen saturation, the other independent predictors of mortality (Cox's proportional hazards: Wald = 21.5, 16.3, 9.91, 7.0 and 6.6, P< 0.0001, <0.0001, 0.002, 0.008, and 0.010, respectively). Patients with systolic dysfunction only (left ventricular ejection fraction ≤50%), diastolic dysfunction only (e'-wave <8 cm/s), or combined systolic and diastolic dysfunction (9.1, 40.4, and 14.1% of the patients, respectively) had higher mortality than those with no diastolic or systolic dysfunction (hazard ratio = 2.9, 6.0, 6.2, P= 0.035, <0.0001, <0.0001, respectively) and had significantly higher serum levels of high-sensitivity troponin-T and N-terminal pro-B-type natriuretic peptide (NT-proBNP). High-sensitivity troponin-T was only minimally elevated, whereas serum levels of NT-proBNP were markedly elevated [median (inter-quartile range): 0.07 (0.02-0.17) ng/mL and 5762 (1001-15 962) pg/mL, respectively], though both predicted mortality even after adjusting for highest creatinine levels (Wald = 5.8, 21.4 and 2.3, P= 0.015, <0.001 and 0.13).. Diastolic dysfunction is common and is a major predictor of mortality in severe sepsis and septic shock.

Topics: Adult; Aged; Critical Care; Echocardiography; Female; Heart Failure, Diastolic; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sepsis; Shock, Septic; Troponin T; Ventricular Dysfunction, Left

We investigated the expression and secretion of the natriuretic peptides (NPs) ANF and BNP in lipopolysaccharide (LPS)-induced sepsis and its association with cytokines and other biologically active substances. LPS treatment increased plasma levels of ANF and BNP. The latter increase was larger than the increase in plasma ANF. LPS also increased cardiac content and gene expression of BNP but not of ANF. LPS treatment significantly increased gene expression cytokines, chemokines and proteases, which significantly correlated with BNP gene expression. SB203580, a p38 MAP kinase inhibitor, inhibited the elevation of BNP in plasma. The present work suggests that during inflammation, BNP gene expression and secretion is uniquely related to changes in gene expression in the absence of hemodynamic changes and hence differentiates ANF and BNP as biomarkers of cardiac disease.

Topics: Animals; Atrial Natriuretic Factor; Biomarkers; Cytokines; Dose-Response Relationship, Drug; Enzyme Inhibitors; Gene Expression Regulation; Imidazoles; Inflammation; Lipopolysaccharides; Myocardium; Natriuretic Peptide, Brain; p38 Mitogen-Activated Protein Kinases; Pyridines; Rats; Rats, Sprague-Dawley; Sepsis; Signal Transduction

The purpose of the study was to evaluate the value of heart-type fatty acid-binding protein (hFABP) as a novel clinical biomarker in patients with severe sepsis.. Serum concentrations of hFABP and traditional cardiac biomarkers including cardiac troponin I, creatine kinase-MB, and B-type natriuretic peptides levels were measured within 6 hours after admission in 93 severe septic patients. The value of hFABP for the diagnosis of sepsis-related myocardial dysfunction (SRMD) and for the prediction of 28-day mortality was evaluated by receiver operating characteristics curve analysis. The prognostic value of elevated hFABP was subsequently confirmed by multivariate Cox proportional hazards analysis and Kaplan-Meier survival analysis.. Heart-type fatty acid-binding protein was elevated (≥ 4.5 ng/mL) in 58 (62.4%) patients; patients with elevated hFABP appeared more likely to have SRMD (84.5% vs 31.4%, P < .001) and have higher prevalence of 28-day death (37.9% vs 8.6%, P = .002). Heart-type fatty acid-binding protein offered superior value over conventional biomarkers in both diagnosis of SRMD (area under the curve, 0.767; P < .001) and prediction of 28-day death (area under the curve, 0.805; P < .001).. Serum hFABP is frequently elevated among patients with severe sepsis and appears to be associated with SRMD. Elevated hFABP independently predicts 28-day mortality in severe sepsis.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Biomarkers; Creatine Kinase, MB Form; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins; Female; Health Status Indicators; Humans; Intensive Care Units; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Proportional Hazards Models; Sensitivity and Specificity; Sepsis; Sex Factors; Troponin I

The prognostic power of n-terminal pro-brain natriuretic peptide (NT-proBNP) in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment (SOFA) score in sepsis.. In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine (Scr1 and Scr3) and NT-proBNP (NT-proBNP1 and NT-proBNP3) were assayed and evaluated at admission and on day 3 respectively.. DNT-proBNP (NT-proBNP3 minus NT-proBNP1) (P < 0.001, Hazard ratio (HR) = 1.245, 95% confidence interval (CI), 1.137 - 1.362) and admission SOFA (P < 0.001, HR = 1.197, 95%CI, 1.106 - 1.295) were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high DNT-proBNP and SOFA had the poorest prognosis.. In our study, both DNT-proBNP and SOFA were independent predictors of septic patients' prognosis. Moreover, the combination of DNT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.

Topics: Aged; Creatinine; Female; Hospital Mortality; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Peptide Fragments; Retrospective Studies; Sepsis

To detect the relationship between the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and prognosis in patients with sepsis.. A prospective controlled study was conducted. Sixty cases, including 39 sepsis and 21 severe sepsis, were enrolled from May 2010 to October 2011 in intensive care unit (ICU) of Second Hospital of Tianjin Medical University. The serum level of NT-proBNP was determined and acute physiology and chronic health evaluation II (APACHEII) score was calculated on the 1st and 3rd day. The receiver operator characteristic curve (ROC curve) was draw. According to the 28-day prognosis, all patients were divided into the survival group (n=42) or the death group (n=18). At the same time 30 healthy people were enrolled as control group.. The level of NT-proBNP in the sepsis patients on the 1st and 3rd day were significantly higher than those of healthy controls (65.77±34.78 ng/L, 74.23±42.12 ng/L vs. 48.36±35.53 ng/L, P<0.05 and P<0.01). The level on 1st day of the severe sepsis group was higher than sepsis group (71.69±32.86 ng/L vs. 50.11±36. 98 ng/L, P<0.05), but there was no statistically significance on the 3rd day. The level of NT-proBNP in death group was increased gradually and significantly higher than that of survival group on the 3rd days (99.20±44.34 ng/L vs. 66.79±39.28 ng/L, P<0.05), but no difference was found on the 1st day. The APACHEII score of severe sepsis group were much higher than those of sepsis group on the 1st and 3rd day (1st day:23.92±7.57 vs. 14.87±6.50, 3rd day:19.28±8.80 vs. 10.43±7.27, both P<0.01). The APACHEII score of death group were also much higher than those of survival group on the 1st and 3rd day (1st day:26.71±6.72 vs. 18.83±7.84, 3rd day:31.11±5.06 vs. 13.80±7.27, both P<0.01). The cut point for the evaluation of sepsis prognosis were NT-proBNP≥63.5 ng/L and APACHEII score≥20, which sensitivity were 65.4% and 88.5%, and specificity were 62.5% and 69.4% respectively.. Serum NT-proBNP levels elevation imply the poor prognosis in patients with sepsis.

Topics: Adult; Aged; Aged, 80 and over; APACHE; Case-Control Studies; Female; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Sepsis; Survival Rate

The prognostic role of B-type natriuretic peptide (BNP) in septic patients is controversial. The study aimed to investigate the prognostic value of BNP in critically ill septic patients. Furthermore, because BNP is primarily released from ventricles in response to myocardial stretch, the second aim of the study was to test whether the change in BNP was correlated to the amount of fluid balance.. This was a prospective observational study conducted in a tertiary 18-bed ICU. Patients fulfilled criteria of sepsis were enrolled. Exclusion criteria included renal dysfunction on ICU entry, age < 18 or >80 years old. BNP was measured on entry (BNP0) and day 3 (BNP1) and daily fluid balance over the three days were recorded. Diagnostic performances of BNP0 and ΔBNP (BNP1-BNP0) were analyzed. The correlation between fluid balance and ΔBNP were tested using Spearman's correlation test.. A total of 67 subjects were eligible for the study during study period. BNP0 was significantly higher in non-survivors than in survivors (738 vs 550 pg/ml, p < 0.01). The area under curves (AUCs) of BNP0 in predicting mortality, duration of mechanical ventilation (MV) > 7 d, length of stay in ICU (LOS(ICU)) > 7 d and hospital (LOS(hospital)) > 12 d were 0.71, 0.79, 0.66 and 0.71, respectively. The AUCs of ΔBNP in predicting duration of MV > 7 d, LOS(ICU) > 7 d and LOS(hospital) > 12 d were 0.80, 0.84 and 0.85, respectively. The amount of fluid balance was correlated to ΔBNP (Spearman's rho = 0.63, p < 0.01), and the correlation remained statistically significant in multivariate model.. BNP measured on ICU entry is associated with mortality, duration of MV, LOS(ICU) and LOS(hospital). ΔBNP is able to predict the LOS(ICU) and LOS(hospital) with satisfactory sensitivity and specificity. ΔBNP is closely correlated to the amount of fluid balance during resuscitation period. However, this could only be considered as a hypothesis-generating pilot study due to its small sample size and the observational nature.

Topics: Adult; Aged; Critical Illness; Female; Fluid Therapy; Hospital Mortality; Humans; Length of Stay; Logistic Models; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Predictive Value of Tests; Sepsis; Statistics, Nonparametric

It is still unclear whether circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflect cardiac filling and function in the critically ill patient, particularly during sepsis and a proinflammatory response that may induce NT-proBNP release from the heart.. We prospectively evaluated the value of NT-proBNP as a marker of cardiac loading, function, and response to fluid loading in 18 septic and 68 nonseptic, critically ill patients in the intensive care unit of a university medical center. Transpulmonary thermal dilution and pressure measurements were done, and plasma NT-proBNP was determined before and after colloid fluid loading.. Compared with nonseptic patients, NT-proBNP plasma levels were higher and systolic cardiac function indices were lower in patients with sepsis than those without sepsis. N-terminal pro-B-type natriuretic peptide best related, from all hemodynamic parameters before and after fluid loading, to systolic cardiac function (rather than diastolic filling) variables, independently of confounders such as renal dysfunction (judged from serum creatinine). In addition, a high NT-proBNP (>3467 pg/mL) predicted absence of fluid responsiveness in sepsis only.. Our data suggest that an increased circulating NT-proBNP plasma level is an independent marker of greater systolic cardiac dysfunction, irrespective of filling status, and is a better predictor of fluid nonresponsiveness in septic vs nonseptic, critically ill patients.

Topics: Academic Medical Centers; Adult; Aged; Biomarkers; Critical Illness; Female; Fluid Therapy; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sepsis; Systole; Treatment Outcome; Ventricular Dysfunction; Young Adult

Myocardial dysfunction is an important aspect of sepsis pathophysiology. B-type natriuretic peptide (BNP) is a neurohormone released from the ventricles in response to myocardial stretch and volume overload. The authors hypothesized that an elevated BNP in patients presenting to the emergency department (ED) with suspected sepsis are at increased risk for development of adverse events.. This was a prospective, observational, multicenter cohort study in 10 EDs. Patients were eligible if they were older than 18 years, had two or more systemic inflammatory response syndrome (SIRS) criteria, and had suspected infection or a serum lactate level > 2.5 mmol/L. Patients were excluded if they were pregnant, had do-not-attempt-resuscitation status, sustained a cardiac arrest prior to hospital arrival, had known chronic renal insufficiency, or were on dialysis. BNP levels were obtained at arrival. The primary outcome was a composite of severe sepsis, septic shock within 72 hours, or in-hospital mortality.. There were 825 patients enrolled (mean ± standard deviation [SD] age = 53.5 ± 19.6 years; 51% were female and 37% were African American). The area under the curve (AUC) for BNP to predict the triple composite outcome was 0.69, and the optimal cut-point of BNP was 49 pg/mL. Patients with a BNP > 49 pg/mL had a greater mortality rate (11.6% vs. 2.1%; p = 0.0001), a greater risk of development of severe sepsis (67.7% vs. 36.8%; p = 0.0001) and septic shock (51.7% vs. 26.4%; p = 0.0001), and a higher rate of the triple composite outcome (69% vs. 37%; unadjusted odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.6 to 2.1; p < 0.001). The sensitivity was 63% (95% CI = 58% to 67%), specificity was 69% (95% CI = 65% to 73%), negative predictive value (NPV) was 63% (95% CI = 58% to 67%), and positive predictive value (PPV) was 69% (95% CI = 65% to 74%). In multivariate modeling, after adjusting for age, sex, heart rate, white blood cell count, and creatinine, an elevated BNP was associated with increased odds of having the composite outcome. The outcome was similar in the subset of patients who did not have severe sepsis or septic shock upon arrival.. In patients who present to the ED with SIRS criteria and suspected infection, an elevated BNP is associated with a worse prognosis but has limited diagnostic utility.

Topics: Adult; Aged; Emergency Service, Hospital; Female; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; ROC Curve; Sepsis; Systemic Inflammatory Response Syndrome; Treatment Failure; United States

B-type natriuretic peptide (BNP) is secreted in response to myocardial stretch and has been used clinically to assess volume overload and predict death in congestive heart failure. More recently, BNP elevation has been demonstrated with septic shock and is predictive of death. How BNP levels relate to cardiac function in sepsis remains to be established.. Retrospective review of prospectively gathered sepsis database from a surgical ICU in a tertiary academic hospital. Initial BNP levels, patient demographics, baseline central venous pressure levels, and in-hospital mortality were obtained. Transthoracic echocardiography was performed during initial resuscitation per protocol.. During 24 months ending in September 2009, two hundred and thirty-one patients (59 ± 3 years of age, 43% male) were treated for sepsis. Baseline BNP increased with initial sepsis severity (ie, sepsis vs severe sepsis vs septic shock, by ANOVA; p < 0.05) and was higher in those who died vs those who lived (by Fisher's exact test; p < 0.05). Of these patients, 153 (66%) had early echocardiography. Low ejection fraction (<50%) was associated with higher BNP (by Fisher's exact test; p < 0.05) and patients with low ejection fraction had a higher mortality (39% vs 20%; odds ratio = 3.03). We found no correlation between baseline central venous pressure (12.7 ± 6.10 mmHg) and BNP (526.5 ± 82.10 pg/mL) (by Spearman's ρ, R(s) = .001) for the entire sepsis population.. In surgical sepsis patients, BNP increases with sepsis severity and is associated with early systolic dysfunction, which in turn is associated with death. Monitoring BNP in early sepsis to identify occult systolic dysfunction might prompt earlier use of inotropic agents.

Topics: Adolescent; Adult; Aged; Biomarkers; Central Venous Pressure; Female; Hospital Mortality; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Retrospective Studies; Sepsis; Stroke Volume; Young Adult

To evaluate the prognostic value of plasma N-Terminal Pro-B-type Natriuretic Peptide (NT-proBNP) in severe sepsis and septic shock.. The blood samples were collect in 72 patients with severe sepsis and septic shock staying in intensive care unit (ICU) at consecutive days. The levels of plasma NT-proBNP, lactate at the 1, 2, 3, 5, 7 day, as well as the levels of CK-MBmass, cTnT and procalcitonin at the 1, 3, 7 day were measured. All the patients were subjected to the calculation of APACHE (acute physiology and chronic ealth evaluation) II scores and SOFA (sequential organ failure assessment) scores,and the clinical outcome, ICU mortality, hospital mortality, ICU time, hospital time, 28-day mortality were collected. The prognostic value of plasma NT-proBNP was analyzed.. Plasma NT-proBNP levels were markedly increased in the patients in our study. The level of NT-proBNP in nonsurvivors at 28 days was higher than that of survivors, and the peak level was emerged on the second day after admission. In multivariate logistic regression analyses, NT-proBNP level at day 3 after inclusion and APACHE II Score were independent predictors of hospital mortality, and only APACHE II Score is the independent predictor for 28-day mortality.. Plasma NT-proBNP level shows obvious increase in patients with severe sepsis and septic shock. NT-proBNP on day 3 in ICU is an independent prognostic marker of hospital mortality in severe sepsis and septic shock.

Topics: Adult; Aged; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis; Shock, Septic; Young Adult

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Risk Factors; Sepsis

Serum amino-terminal pro-brain natriuretic peptide (NT-proBNP) is considered as a prognostic marker in patients with severe sepsis or septic shock, but no data are available on NT-proBNP kinetics in hematological patients with neutropenic fever. Altogether 70 hematological patients with neutropenic fever were included in this prospective study. NT-proBNP and C-reactive protein (CRP) were determined at the beginning of the neutropenic fever (d0) and then daily up to 3-4 days. The median NT-proBNP (interquartile range) increased from 127 (57-393) ng/L on d0 to 542 (194-1385) ng/L on d4. The increment of CRP was from 35 (17-61) mg/L on d0 to 109 (56-109) mg/L on d2. Neither serial NT-proBNP nor CRP predicted development of severe sepsis, but NT-proBNP was significantly higher in patients with previous cardiovascular disease than in those without. NT-proBNP seemed to reflect cardiac distress, but it did not help to predict the development of severe sepsis in this patient group.

Topics: Adolescent; Adult; Aged; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Female; Fever; Hematologic Diseases; Humans; Kinetics; Male; Middle Aged; Natriuretic Peptide, Brain; Neutropenia; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Sepsis; Young Adult

To evaluate the value of B-type natriuretic peptide (BNP) in predicting the outcome of severe sepsis and septic shock patients.. One hundred and two patients with severe sepsis and septic shock were prospectively observed. Plasma BNP level was measured at 24th hour after admission to intensive care unit (ICU) of a university hospital. The data of clinical features, 28-day mortality, acute physiology and chronic health evaluation II (APACHE II) scores and the length of stay (LOS) in ICU were collected. The patients were divided into survival group and non-survival group. The survival group was further divided into BNP elevated group and BNP normal group.. APACHE II scores were significantly higher in non-survivors (39 patients) compared with survivors (63 patients, 28.9+/-5.9 vs. 20.2+/-5.4, P<0.01), but there were no statistical difference of white blood cell count and blood lactic levels between two groups. BNP levels were significantly higher in non-survivors compared with survivors [(1,451.3+/-531.7) ng/L vs. (394.5+/-81.7) ng/L, P<0.01]; BNP greater than 681.4 ng/L at first 24th hour was an independent indicator of mortality (sensitivity 91.4%, specificity 80.3%). In survivals, the LOS in ICU was significantly higher in BNP elevated group (48 patients) than BNP normal group [15 patients, (23.7+/-7.5) days vs. (14.9+/-5.1) days, P<0.05), but APACHE II scores showed no statistical difference between two groups.. Plasma BNP level is a valuable prognostic factor for severe sepsis and septic shock patients.

Topics: APACHE; Female; Humans; Male; Natriuretic Peptide, Brain; Prognosis; ROC Curve; Sepsis; Shock, Septic

The study was conducted to know the significance of brain natriuretic peptide (BNP) for prognosis of septic patients.. The subjects were 1000 patients selected in emergency department of Beijing Chaoyang Hospital of the Capital Medical University (Beijing, China) and were classified into 3 groups as follows: systemic inflammatory response syndrome (SIRS), non-SIRS, and sepsis groups. Plasma serum brain natriuretic peptide (BNP) levels and the positive detection rates of BNP were examined. The BNP level of 100 pg/mL or more was regarded as positive, and then the positive detection rates of BNP of these groups were compared. The prognostic values of BNP and APACHE (Acute physiology and chronic health evaluation) II score for the 28-day mortality were investigated, and their cutoff values for death were determined.. There were significant differences in the positive detection rates of BNP between any 2 groups and in 28-day mortality between the patients with SIRS and non-SIRS groups. The BNP level had positive correlation to APACHE II score in 3 groups. Brain natriuretic peptide level of more than 113 pg/mL was independent predictor of death in septic patients.. The positive rates of BNP in SIRS and septic patients were significantly higher than that of non-SIRS patients, and this is an index for unfavorable prognosis in septic patients.

Topics: Aged; APACHE; Biomarkers; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; ROC Curve; Sensitivity and Specificity; Sepsis; Systemic Inflammatory Response Syndrome

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Prognosis; Sepsis; Systemic Inflammatory Response Syndrome

Neonatal sepsis can cause multiple organ dysfunction syndrome, especially including myocardial injury and heart failure. In this study, the authors observed the changes and the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide in myocardial injury of neonatal sepsis at the different stages to search for the early diagnostic index of myocardial injury and heart failure in patients with neonatal septicemia.. The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were determined in 96 newborns with neonatal septicemia according to the diagnosis and treatment program of neonatal septicemia in 2003. The 96 cases were divided into myocardial injury group and non-myocardial injury group. Every newborn was tested for the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide with enzyme-linked immunosorbent assay (ELISA) on the second day, fifth day and tenth day of septicemia and in the different gestational age infants. Meanwhile, the results were compared to creatine kinase isoenzyme and troponin I.. The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly different between myocardial injury group and non-myocardial injury group at the fifth day (P<0.05), especially the levels of plasma N-terminal pro-B-type natriuretic peptide were significantly elevated at the early stage (on the second day) between the two groups (P<0.05). On the fifth day, the values of plasma N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L in myocardial injury group, but the value of non-myocardial injury group was (179.3 +/- 27.5) pmol/L. On the fifth day, the results of plasma brain natriuretic peptide, N-terminal pro-B-type natriuretic peptide and troponin I were significantly different and had statistical significance between the myocardial injury group and non-myocardial injury group (P<0.05), while the results of creatine kinase isoenzyme had no statistically significant difference (P>0.05). The values of plasma brain natriuretic peptide were respectively (215.5 +/- 69.6) pmol/L and (119.3 +/- 37.4) pmol/L, While N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L and (179.3 +/- 27.5) pmol/L in the two groups. The value of troponin I was (1.57 +/- 0.39) microg/L in the myocardial injury group and that in the non-myocardial injury group was (0.55 +/- 0.2) microg/L. The values of creatine kinase isoenzyme were (33.3 +/- 10.1) u/L in the myocardial injury group, but that of non-myocardial injury group was (17.4 +/- 8.5) u/L. In the different gestational age infants, the values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide of premature infants were the highest in the three groups. The values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were (159.5 +/- 39.6) pmol/L and (238.5 +/- 49.7) pmol/L in premature infants.. The levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide evidently increased in myocardial injury of neonatal sepsis, especially in premature infants. The increase of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide may be helpful in early diagnosis of the myocardial injury of neonatal sepsis associated with cTnI. N-terminal pro-B-type natriuretic peptide may become a useful index to diagnose the myocardial injury and should be widely used in the neonatal intensive care unit.

Topics: Female; Heart Injuries; Humans; Infant, Newborn; Male; Natriuretic Peptide, Brain; Sepsis

Recent papers discussed include two large, multicentre, high-positive end-expiratory pressure trials in acute lung injury and reflects upon the usefulness of such trial designs. Further papers considered include the emerging story of beta2-agonists for pulmonary oedema, highlights the newly described, iatrogenic demon, of ventilator-induced diaphragm injury, promotes the addition of B-type natriuretic peptide testing to the prediction of extubation success, and muses again over the oxygen debate.

Topics: Adrenergic beta-Agonists; Animals; Critical Illness; Diaphragm; Humans; Hyperoxia; Muscular Atrophy; Natriuretic Peptide, Brain; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Pulmonary Edema; Randomized Controlled Trials as Topic; Respiration, Artificial; Respiratory Distress Syndrome; Sepsis; Ventilator Weaning

Myocardial dysfunction is a complication associated with a poor prognosis in septic patients. A biomarker of cardiac function providing prognostic information is of paramount interest.. We sought to determine the value of B-type natriuretic peptide in patients with severe sepsis/septic shock.. We performed a prospective study in patients with severe sepsis/septic shock in a medical intensive care unit. B-type natriuretic peptide level was determined within 24 hours after the diagnosis of severe sepsis/septic shock. We also analyzed mortality, and presence of association between B-type natriuretic peptide and clinical, hemodynamic and respiratory variables.. 23 (9 women; 14 men) patients with ages ranging from 20-79 (mean 51.3+/-18.6) years old and APACHE score of 22.6+/-11.8 were included; 15 (65.2%) patients received pulmonary artery catheters, and 20 (87%) were mechanically ventilated. Multivariate analysis disclosed inverse association between B-type natriuretic peptide values with positive end-expiratory pressure values, and direct association with creatinine (beta 0.548 and 0.377, p 0.02 and 0.002, respectively), but not with mortality, clinical and hemodynamic parameters.. This is the first report on an inverse association between positive end-expiratory pressure and BNP levels in patients with severe sepsis and septic shock. BNP and creatinine levels should be taken into consideration when analyzing B-type natriuretic peptide levels in this setting.

Topics: Adult; Aged; Biomarkers; Creatinine; Female; Humans; Kidney; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Positive-Pressure Respiration; Predictive Value of Tests; Prognosis; Prospective Studies; Sepsis; Shock, Septic; Young Adult

In early stages of septic shock, impaired myocardial function plays an important prognostic role. In this context, B-type natriuretic peptide (BNP) has been shown to be a neurohumoral marker for left ventricular dysfunction, because myocardial strain and ischemia both increase BNP concentration. The present study was designed to test if BNP allows for identification of patients at risk for developing sepsis-induced myocardial depression and if an increased concentration of BNP is associated with an adverse outcome in patients with septic shock.. In a prospective study, 93 patients with septic shock were divided into one group with normal ventricular function (left ventricular ejection fraction >50%) on days 3 to 5 (n = 38) and another group of patients with impaired left ventricular function (left ventricular ejection fraction <50%) on days 3 to 5 (n = 55). Patients with impaired left ventricular function had an increased median plasma BNP concentration on day 5 (699 [608 of 795.5] pg/nL vs. 86 [71.3 of 93] pg/nL) and an ejection fraction of 38 +/- 6% on day 5 vs. 58 +/- 7% in patients without impaired left ventricular function. There was a close inverse relation between increased plasma BNP concentrations and depressed left ventricular ejection fraction (p < 0.05). BNP measured at days 3 and 5 revealed an association with the end point of survival. In the proportional hazards regression model adjusted for age, male gender, and creatinine concentration, measured at days 0, 3, 5, and 12, BNP concentration at day 5 showed an increased hazard for reaching the end point (hazard ratio: 1.407; 95% confidence interval: 1.033-1.916; p = 0.030). In an additional receiver operating characteristic curve analysis, the predictive value of a model including cardiovascular risk factors and additional BNP concentration on day 5, compared with a baseline model of cardiovascular risk factors, improved the area under the curve the most; therefore, this model was suited best for prediction of sepsis-induced myocardial depression and 30-day survival for patients with septic shock. Area under the curve of this model combined with BNP concentration at day 5 for death after 30 days (0.65) impaired left ventricular ejection fraction (0.94) and sepsis-induced myocardial depression (0.96).. These results indicate that plasma BNP concentration represents a reliable marker for identification of patients developing sepsis-induced myocardial depression. In addition, BNP concentration on day 5 may be used as a prognostic marker to identify patients with an elevated risk for an adverse outcome.

Topics: Aged; Biomarkers; Critical Care; Female; Humans; Male; Middle Aged; Models, Cardiovascular; Multivariate Analysis; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; ROC Curve; Sepsis; Shock, Septic; Ventricular Dysfunction, Left

Topics: Biomarkers; Case-Control Studies; Critical Illness; Female; Humans; Male; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Reference Values; Risk Assessment; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Shock, Septic; Survival Analysis

To explore the diagnostic value of brain natriuretic peptide (BNP) level in patients with sepsis of blood-stasis syndrome.. The prospective method of clinical diagnostic test and evaluation principles of diagnostic test were applied. One hundred and seventy-four patients with sepsis were divided into two groups: blood-stasis syndrome group and non blood-stasis syndrome group. The levels of serum BNP in two groups were detected.. The level of BNP in sepsis patients was related to blood-stasis syndrome (P<0.01). BNP cut-off level was 150 ng/L, sensitivity was 85.3%, specificity was 81%, the maximum value of Youden index was 0.663, and the area under the receiver operating characteristic curve (ROC) value was (0.886+/-0.025).. BNP can be used as an objective index of blood-stasis syndrome diagnosis for sepsis, and BNP with boundary value of 150 ng/L is an optimal biological index.

Topics: Aged; Aged, 80 and over; Biomarkers; Diagnosis, Differential; Female; Humans; Male; Medicine, Chinese Traditional; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Sepsis

The aim of this study was to find the relationship between N-terminal brain natriuretic propeptide (NT-proBNP), procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations in septic patients. This was a prospective study, performed at Medical University Hospital No. 5 in łódź. Twenty patients with sepsis and severe sepsis were included in the study. N-terminal brain natriuretic propeptide, procalcitonin and C-reactive protein concentrations, and survival were evaluated. In the whole studied group (128 measurements), the mean NT-proBNP, procalcitonin and C-reactive protein concentrations were, respectively: 140.80+/-84.65 pg/ml, 22.32+/-97.41 ng/ml, 128.51+/-79.05 mg/l. The correlations for the NT-proBNP level and procalcitonin and C-reactive protein levels were 0.3273 (p<0.001) and 0.4134 (p<0.001), respectively. NT-proBNP levels correlate with PCT and CRP levels in septic patients. In the survivor subgroup, the mean NT-proBNP plasma concentrations were significantly lower than in the non-survivor subgroup.

Topics: Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Protein Precursors; Sepsis

Topics: Acute Disease; Heart Failure; Humans; Natriuretic Peptide, Brain; Sepsis; Severity of Illness Index; Shock, Septic

To investigate the changes in B-type natriuretic peptide concentrations in patients with severe sepsis and septic shock and to investigate the value of B-type natriuretic peptide in predicting intensive care unit outcomes.. Prospective observational study.. General intensive care unit.. Forty patients with severe sepsis or septic shock.. None.. B-type natriuretic peptide measurements and echocardiography were carried out daily for 10 consecutive days. In-hospital mortality and length of stay were recorded. The admission B-type natriuretic peptide concentrations were generally increased (747 +/- 860 pg/mL). B-type natriuretic peptide levels were elevated in patients with normal left ventricular systolic function (568 +/- 811 pg/mL), with sepsis-related reversible cardiac dysfunction (630 +/- 726 pg/mL), and with chronic cardiac dysfunction (1311 +/- 1097 pg/mL). There were no significance changes in B-type natriuretic peptide levels over the 10-day period. The daily B-type natriuretic peptide concentrations for the first 3 days neither predicted in-hospital mortality nor correlated with length of intensive care unit or hospital stay.. B-type natriuretic peptide concentrations were increased in patients with severe sepsis or septic shock regardless of the presence or absence of cardiac dysfunction. Neither the B-type natriuretic peptide levels for the first 3 days nor the daily changes in B-type natriuretic peptide provided prognostic value for in-hospital mortality and length of stay in this mixed group of patients, which included patients with chronic cardiac dysfunction.

Topics: Aged; Biomarkers; Echocardiography; Female; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Prospective Studies; Sepsis; Shock, Septic

Topics: Biomarkers; Humans; Intensive Care Units; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Sepsis; Shock, Septic

The aim of this study was to evaluate the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality in a large, unselected patient population with severe sepsis and septic shock.. Prospective observational cohort study about incidence and prognosis of sepsis in 24 intensive care units in Finland (the FINNSEPSIS study).. A total of 254 patients with severe sepsis or septic shock.. After informed consent, the blood tests for NT-proBNP analyses were drawn on the day of admission and 72 hrs thereafter. Patients' demographic data were collected, and intensive care unit and hospital mortality and basic hemodynamic and laboratory data were recorded daily.. NT-proBNP levels at admission were significantly higher in hospital nonsurvivors (median, 7908 pg/mL) compared with survivors (median, 3479 pg/mL; p = .002), and the difference remained after 72 hrs (p = .002). The receiver operating characteristic curves of admission and 72-hr NT-proBNP levels for hospital mortality resulted in area under the curve values of 0.631 (95% confidence interval, 0.549-0.712; p = .002) and 0.648 (95% confidence interval, 0.554-0.741; p = .002), respectively. In logistic regression analyses, NT-proBNP values at 72 hrs after inclusion and Simplified Acute Physiology Score for the first 24 hrs were independent predictors of hospital mortality. Pulmonary artery occlusion pressure (p < .001), plasma creatinine clearance (p = .001), platelet count (p = .03), and positive blood culture (p = .04) had an independent effect on first-day NT-proBNP values, whereas after 72 hrs, only plasma creatinine clearance (p < .001) was significant in linear regression analysis.. NT-proBNP values are frequently increased in severe sepsis and septic shock. Values are significantly higher in nonsurvivors than survivors. NT-proBNP on day 3 in the intensive care unit is an independent prognostic marker of mortality in severe sepsis.

Topics: Aged; Area Under Curve; Arterial Occlusive Diseases; Biomarkers; Cohort Studies; Creatinine; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Observation; Peptide Fragments; Platelet Count; Prognosis; Prospective Studies; Pulmonary Artery; ROC Curve; Sensitivity and Specificity; Sepsis; Shock, Septic

Topics: Age Factors; Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis; Sex Factors; Shock, Septic

Elevated B-type natriuretic peptide (BNP) levels are established as a marker for volume overload and left ventricular (LV) dysfunction in patients with predominately cardiac diseases. Little is known about markedly elevated BNP values in patients with multiple comorbidities.. A total of 99 patients, admitted to M. D. Anderson Cancer Center, were identified as having a BNP value >1000 pg/mL during the year 2003. Clinical characteristics, including the presence of volume overload and sepsis, as well as echocardiographic parameters were measured. Principal outcome was defined as 30-day mortality.. The median BNP (pg/mL) of the group was 2270 (range, 1010-5000), and there was no association between elevation of the BNP level and the presence of volume overload or LV dysfunction (P = not significant). The large majority of patients (n = 71, 72%) had no volume overload and normal or nearly normal LV function (n = 60, 61%). A majority were also identified as having sepsis (n = 52, 53%). There was no echocardiographic parameter that consistently correlated with BNP levels or volume overload. There was a highly significant association with sepsis and mortality in patients with markedly elevated BNP values, and this conferred a 2.71-fold increased risk of mortality.. In patients admitted with multiple comorbidities and markedly elevated BNP values, there is no significant association with clinical evidence of volume overload or LV dysfunction. An elevated BNP level in patients with sepsis was significantly associated with mortality.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cardiovascular Diseases; Diabetes Complications; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Neoplasms; Prognosis; Sepsis; Water-Electrolyte Imbalance

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Sepsis

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Sepsis

Topics: Humans; Molecular Weight; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sepsis; Ventricular Dysfunction, Left

In addition to its importance in clinical assessment, N-terminal pro-brain natriuretic peptide (NT pro-BNP) is a valuable marker for evaluation of treatment and prognosis of heart failure. However, there are situations where NT pro-BNP is not related to myocardial dysfunction. Two cases of sepsis with markedly elevated NT pro-BNP levels that are not indicative of depressed myocardial function are described.

Topics: Aged; Aged, 80 and over; Biomarkers; Fatal Outcome; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Sepsis

B-type natriuretic peptide (BNP) and N-terminal pro-BNP measurements are used for the diagnosis of congestive heart failure (HF). However, the diagnostic value of these tests is unknown under septic conditions. We compared patients with severe sepsis or septic shock and patients with acute HF to unravel the influence of the underlying diagnosis on BNP and N-terminal pro-BNP levels.. Prospective, clinical study.. Academic medical intensive care unit (ICU).. A total of 249 consecutive patients were screened for the diagnosis of sepsis or HF. Sepsis was defined according to published guidelines. HF was diagnosed in the presence of an underlying heart disease and congestive HF, pulmonary edema, or cardiogenic shock.. BNP and N-terminal pro-BNP were measured from blood samples that were drawn daily for routine analysis.. We identified 24 patients with severe sepsis or septic shock and 51 patients with acute HF. At admission, the median (range) BNP and N-terminal pro-BNP levels were 572 (13-1,300) and 6,526 (198-70,000) ng/L in patients with sepsis and 581 (6-1,300) and 4,300 (126-70,000) ng/L in patients with HF. The natriuretic peptide levels increased during the ICU stay, but the differences between the groups were not significant. Nine patients with sepsis and eight patients with HF were monitored with a pulmonary artery catheter. Mean (sd) pulmonary artery occlusion pressure were 16 (4.2) and 22 (5.3) mm Hg (p = .02), and cardiac indexes were 4.6 (2.8) and 2.2 (0.6) L/min/m (p = .03) in patients with sepsis and HF, respectively. Despite these clear hemodynamic differences BNP and N-terminal pro-BNP levels were not statistically different between the two groups.. In patients with severe sepsis or septic shock, BNP and N-terminal pro-BNP values are highly elevated and, despite significant hemodynamic differences, comparable with those found in acute HF patients. It remains to be determined how elevations of natriuretic peptide levels are linked to inflammation and sepsis-associated myocardial dysfunction.

Topics: Acute Disease; Aged; Blood Pressure; Female; Heart Failure; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sepsis; Sex Factors; Shock, Septic

Topics: Biomarkers; Heart Failure; Humans; Intensive Care Units; Natriuretic Peptide, Brain; Peptide Fragments; Sepsis

N-terminal pro-B-type natriuretic peptide has been shown to be a marker for cardiac dysfunction. The peptide level is also elevated in patients with sepsis. The purpose of this study was to assess whether N-terminal pro-B-type natriuretic peptide levels can differentiate pediatric patients with sepsis from patients with acute left ventricular dysfunction.. Pediatric patients admitted to an ICU with sepsis or acute left ventricular dysfunction were evaluated clinically, and the grade of systemic inflammatory-response syndrome was determined. Echocardiography was performed, and their levels of N-terminal pro-B-type natriuretic peptide were measured. The N-terminal pro-B-type natriuretic peptide level was also measured in patients with simple febrile illness.. There were 10 patients with sepsis and 10 with acute left ventricular dysfunction. The age of the patients was similar, and systemic inflammatory-response syndrome grading was not different (sepsis: 2.8 +/- 0.4; acute left ventricular dysfunction: 2.6 +/- 0.7). N-terminal pro-B-type natriuretic peptide levels were elevated in patients with sepsis (median: 6064 pg/mL; range: 495-60,417 pg/mL) but were significantly higher in patients with acute left ventricular dysfunction (median: 65,630 pg/mL; range: 15,125-288,000). The area under the receiver operating characteristics curve for the diagnosis of acute left ventricular dysfunction was 0.9. N-terminal pro-B-type natriuretic peptide levels of patients with sepsis and impaired systolic function were not different from those of patients with sepsis and normal systolic function. The N-terminal pro-B-type natriuretic peptide levels of 20 patients with simple febrile illness were significantly lower.. N-terminal pro-B-type natriuretic peptide levels are elevated in pediatric patients with sepsis but are higher in some, but not all, patients with acute left ventricular dysfunction. The overlap between N-terminal pro-B-type natriuretic peptide levels in sepsis and acute left ventricular dysfunction precludes the use of the peptide's level as a sole means to differentiate between these conditions. Excessive elevation in N-terminal pro-B-type natriuretic peptide levels, however, suggests cardiac etiology for acute hemodynamic deterioration in infants and children.

Topics: Acute Disease; Child; Child, Preschool; Critical Illness; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain; Peptide Fragments; Reference Values; Sensitivity and Specificity; Sepsis; Ventricular Dysfunction, Left

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

B-type natriuretic peptide is known to predict outcome in congestive cardiac failure and myocardial infarction. We aimed to determine whether measurement of B-type natriuretic peptide would predict hospital mortality in patients admitted to an intensive care unit. We conducted a prospective observational cohort study in 78 consecutive patients. Demographics, clinical details and clinical outcomes were recorded. Admission and 24 h B-type natriuretic peptide and cardiac troponin I levels were measured. B-type natriuretic peptide and cardiac troponin I levels taken on intensive care admission and 24 h after admission did not accurately predict hospital mortality for all patients, including patients with severe sepsis or septic shock (all p > 0.05). B-type natriuretic peptide levels were higher in patients with severe sepsis and septic shock (p = 0.02), in patients > or = 65 years (p = 0.04) and in patients with raised creatinine > or = 110 micromol.l(-1) (p = 0.02). We concluded that B-type natriuretic peptide, measured soon after admission to intensive care, does not usefully predict outcome after intensive care.

Topics: Aged; APACHE; Biomarkers; Creatinine; Critical Care; Female; Hospital Mortality; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Reference Values; Sepsis; Survival Analysis; Troponin I

Increased plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) have been identified as predictors of cardiac dysfunction and prognosis in congestive heart failure and ischemic heart disease. In severe sepsis patients, however, no information is available yet about the prognostic value of natriuretic peptides. Therefore, the aim of the present study was to determine the role of the N-terminal prohormone forms of ANP (NT-proANP) and BNP (NT-proBNP) in the context of outcome of septic patients. Furthermore, the effect of treatment with recombinant human activated protein C [drotrecogin alfa (activated)] on plasma levels of natriuretic peptides in severe sepsis was evaluated.. Fifty-seven patients with severe sepsis were included. Levels of NT-proANP and NT-proBNP were measured on the second day of sepsis by ELISA. Septic patients with NT-proBNP levels >1400 pmol/L were 3.9 times more likely (relative risk [RR], 3.9; 95% CI, 1.6 to 9.7) to die from sepsis than patients with lower NT-proBNP values (P<0.01). NT-proANP levels, however, were not predictive of survival in our patient population. A highly significant correlation was found between troponin I levels and plasma concentrations of NT-proBNP in septic patients (r=0.68, P<0.0001). In addition, troponin I significantly accounted for the variation in NT-proBNP levels (P<0.0001), suggesting an important role for NT-proBNP in the context of cardiac injury and dysfunction in septic patients. Twenty-three septic patients who received treatment with drotrecogin alfa (activated) presented with significantly lower concentrations of NT-proANP, NT-proBNP, and troponin I compared with patients not receiving drotrecogin alfa (activated).. NT-proBNP may serve as useful laboratory marker to predict survival in patients presenting with severe sepsis.

Topics: Adult; Aged; APACHE; Atrial Natriuretic Factor; Blood Pressure; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein C; Recombinant Proteins; Sepsis; Troponin I; Ventricular Function, Left

The family of natriuretic peptides comprises several structurally related 22-53-amino acid peptides, such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), which are vasoactive peptides with vasodilator and diuretic properties and play an important role in cardiovascular homeostasis. The salutary cardiovascular effects of natriuretic peptides suggest that ANP and BNP may have a pathophysiological significance in the cardiac dysfunction of septic patients. We determined plasma levels of the stable N-terminal prohormone forms of ANP (NT-proANP) and BNP (NT-proBNP) as well as troponin I (TNI) as a marker of myocardial cell injury by ELISA methods in 19 septic patients and 19 healthy controls at day one of severe sepsis. Left ventricular ejection fraction (LVEF) was determined on day 1 of severe sepsis by echocardiography. Significantly higher concentrations of NT-proANP were measured in non-survivors (mean = 13415 pmol/l +/- SEM = 4295) and survivors (mean = 7386 pmol/l +/- SEM = 1807) as compared to controls (mean = 1404 pmol/l +/- SEM = 181; p<0.001). Levels of NT-proBNP were also significantly higher in non-survivors (mean = 3439 pmol/l +/- SEM = 1246; p<0.05) and survivors (mean = 1009 pmol/l +/- SEM = 263; p<0.001) as compared to controls (mean = 200 pmol/l +/- SEM = 24) and correlated well with an increase in TNI-levels (r = 0.71; p<0.001). NT-proANP and NT-proBNP may serve as useful laboratory markers to indicate myocardial dysfunction and may help to differentiate between survivors and non-survivors of severe sepsis.

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Sepsis; Treatment Outcome; Troponin I; Ventricular Dysfunction, Left

Topics: Aged; Biomarkers; Female; Follow-Up Studies; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Sepsis; Severity of Illness Index; Stroke Volume; Ventricular Dysfunction, Left

To investigate the value of brain natriuretic peptide plasma levels as a marker of systolic myocardial dysfunction during severe sepsis and septic shock.. Prospective observational study.. Intensive care unit.. A total of 34 consecutive patients with severe sepsis (nine patients) or septic shock (25 patients) without previous cardiac, respiratory, or chronic renal failure.. None.. Myocardial systolic performance was assessed by fractional area contraction (FAC) using echocardiography performed on days 2 (FACD2) and 8. Plasma levels of brain natriuretic peptide were measured at days 1-4 and 8 after the beginning of severe sepsis. Among 34 patients (Simplified Acute Physiology Score II, 43 +/- 2.5), 15 (44%) presented with initial myocardial dysfunction (FACD2 < 50%). Lungs were the origin of sepsis in 65% of patients. The 28-day mortality was 29%. Comparisons were performed between patients with (FACD2 < 50%) and without (FACD2 > or = 50%) myocardial dysfunction. Plasma levels of brain natriuretic peptide were significantly higher in patients with FACD2 < 50% than in those with FACD2 > or = 50% (p <.05) from day 2 to day 4. Brain natriuretic peptide levels were also significantly higher on days 2 and 3 in patients who died during their intensive care unit stay (p <.05).. Systolic myocardial dysfunction is present in 44% of patient with severe sepsis or septic shock. In this setting, brain natriuretic peptide seems useful to detect myocardial dysfunction, and high plasma levels appear to be associated with poor outcome of sepsis, but further studies are needed.

Topics: Analysis of Variance; Biomarkers; Cardiomyopathies; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Observation; Paris; Prognosis; Prospective Studies; Sepsis; Shock, Septic; Survival Analysis