natriuretic-peptide--brain and Shock--Septic

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

To conduct a systematic review evaluating the utility of brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) as biomarkers in adult patients with septic shock.. Pubmed/Medline databases were searched from inception to November 2018 using the search terms: (septic[Title/Abstract] AND shock[Title/Abstract]) AND bnp[Title/Abstract]) and (septic[Title/Abstract]) AND shock[Title/Abstract]) AND natriuretic[Title/Abstract]). No restriction was applied regarding date of publication. Comparative observational studies evaluating BNP and NT-proBNP in patients with septic shock aged ≥18 years were eligible for inclusion. Bibliographies from the extracted articles were also reviewed to identify additional relevant publications.. In total, 46 studies met all eligibility criteria and were included. A strong body of literature has demonstrated that in patients with septic shock, increased values of BNP and NT-proBNP are associated with increased mortality. An increase from baseline BNP values has also been associated with increased mortality, whereas decreases from baseline values are not related to worse outcome. Brain natriuretic peptides have also been associated with cardiac dysfunction in patients with sepsis. Moreover, BNP values have been found to be significantly elevated in septic shock, regardless of cardiac dysfunction, and have been used to distinguish between septic and cardiogenic shock. Furthermore, BNP and NT-proBNP are significantly increased in patients with septic shock, compared to patients with sepsis and severe sepsis.. BNP and NT-proBNP appear to be reliable predictors of outcome in septic shock.

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Sensitivity and Specificity; Shock, Cardiogenic; Shock, Septic

In the last three decades many members of the natriuretic peptide family was isolated. The function and physiological role of these peptides are pleiotropic. All natriuretic peptides are synthesized from polypeptide precursors. Together with the sympathetic nervous system and other hormones they play key roles, like an endogenous system in the regulation of the body fluid homeostasis and blood pressure. Changes in this balance lead to dysfunction in the endothel and left ventricle, which can cause severe complications. In many cardiovascular diseases natriuretic peptides serve not only as marker for diagnosis and prognosis but they have therapeutic importance. In the last years the potential use of the elevated BNP levels for diagnosis of pre-eclampsia was examined. In our review we discuss the current understanding of molecular biology, biochemistry and clinical relevance of natriuretic peptides.

Topics: Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Cardiovascular Diseases; Female; Humans; Liver Cirrhosis; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Natriuretic Peptides; Pre-Eclampsia; Pregnancy; Renal Insufficiency; Shock, Septic; Tissue Distribution

Natriuretic peptides are markers of heart failure and/or cardiac dysfunction that provide useful diagnostic and prognostic information in patients with dyspnea and/or respiratory failure in the emergency department. Cardiac troponins (cTn) have markedly simplified the diagnosis of myocardial infarction. In critically ill patients, conditions like coexisting organ dysfunction multiorgan involvement or altered synthesis/clearance may confound interpretation of designated biomarkers, including natriuretic peptides and cTn. This review focuses on recently published articles relating to the use of natriuretic peptides and cTn in critically ill patients.. One new study addresses diagnostic utility of B-type natriuretic peptide to distinguish low-pressure pulmonary edema (acute lung injury/acute respiratory distress syndrome) from high-pressure (cardiogenic) pulmonary edema. Other studies highlight the prognostic value of natriuretic peptides either in unselected and general noncardiac ICU patients and reveal an important reason for elevated B-type natriuretic peptide levels in septic shock.Interesting data focusing on diagnostic and prognostic ability of systematic cTn screening measurements in ICU patients became available.. Recent studies confirm the excellent prognostic value of natriuretic peptide measurements in ICU patients. Diagnostic properties of natriuretic peptide in ICU patients still remain ambiguous and require further evaluation. Systematic screening with cTn reveals more myocardial infarctions and provides important prognostic information.

Topics: Biomarkers; Cardiovascular Diseases; Critical Illness; Diagnosis, Differential; Emergency Service, Hospital; Humans; Intensive Care Units; Myocardial Infarction; Natriuretic Peptide, Brain; Natriuretic Peptides; Prognosis; Pulmonary Edema; Shock, Septic; Troponin T

We review key research papers in cardiology and intensive care published during 2008 in Critical Care. We quote studies on the same subject published in other journals if appropriate. Papers have been grouped into three categories: (a) cardiovascular biomarkers in critical illness, (b) haemodynamic management of septic shock, and (c) haemodynamic monitoring.

Topics: Biomarkers; Cardiology; Cardiovascular Physiological Phenomena; Catheterization, Central Venous; Critical Care; Critical Illness; Hemodynamics; Humans; Lactates; Monitoring, Physiologic; Natriuretic Peptide, Brain; Oximetry; Shock, Septic

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

Brain natriuretic peptide (BNP) is a diagnostic marker for left ventricular dysfunction. Sepsis and septic shock are increasing in incidence and mortality. Myocardial dysfunction frequently accompanies severe sepsis and septic shock. Although previously described as a preterminal event, ventricular dysfunction with reduced ejection fraction and biventricular dilatation is present in most patients with severe sepsis and septic shock. In survivors, this depression in cardiac function is reversible over the course of seven to ten days. Even though some prognostic factors have been identified in patients with sepsis-induced myocardial dysfunction, their measurement often includes costly and cumbersome techniques. Thus, there is a need for an inexpensive, simple, rapid and readily available marker to predict mortality in septic shock. At present, a relationship between BNP with myocardial dysfunction in septic shock has not been evaluated. However, growing evidence supports the hypothesis that BNP could be an early predictor of mortality in septic shock. If proven, the hypothesis would have important clinical and public health implications.

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Shock, Septic; Ventricular Dysfunction, Left

Myocardial dysfunction is common in sepsis but optimal treatment strategies are unclear. The inodilator, levosimendan was suggested as a possible therapy; however, the levosimendan to prevent acute organ dysfunction in Sepsis (LeoPARDS) trial found it to have no benefit in reducing organ dysfunction in septic shock. In this study we evaluated the effects of levosimendan in patients with and without biochemical cardiac dysfunction and examined its non-inotropic effects.. Two cardiac biomarkers, troponin I (cTnI) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and five inflammatory mediators were measured in plasma from patients recruited to the LeoPARDS trial at baseline and over the first 6 days. Mean total Sequential Organ Failure Assessment (SOFA) score and 28-day mortality were compared between patients with normal and raised cTnI and NT-proBNP values, and between patients above and below median values.. Levosimendan produced no benefit in SOFA score or 28-day mortality in patients with cardiac dysfunction. There was a statistically significant treatment by subgroup interaction (p = 0.04) in patients with NT-proBNP above or below the median value. Those with NT-proBNP values above the median receiving levosimendan had higher SOFA scores than those receiving placebo (mean daily total SOFA score 7.64 (4.41) vs 6.09 (3.88), mean difference 1.55, 95% CI 0.43-2.68). Levosimendan had no effect on the rate of decline of inflammatory biomarkers.. Adding levosimendan to standard care in septic shock was not associated with less severe organ dysfunction nor lower mortality in patients with biochemical evidence of cardiac dysfunction.

Topics: Aged; Biomarkers; Chemokine CCL2; Double-Blind Method; Female; Heart Diseases; HSP90 Heat-Shock Proteins; Humans; Intensive Care Units; Interleukin-10; Interleukin-6; Interleukin-8; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Peptide Fragments; Prognosis; Shock, Septic; Simendan; Troponin I; United Kingdom

We hypothesized that aromatic microbial metabolites (AMM), such as phenyllactic (PhLA), p-hydroxyphenylacetic (p-HPhAA), and p-hydroxyphenyllactic (p-HPhLA) acids, contribute to the pathogenesis of septic shock.. Clinical and laboratory data of patients with community-acquired pneumonia were obtained on intensive care unit admission and the next day. Patients were divided into two groups based on septic shock presence or absence. The levels of AMM (PhLA, p-HPhAA, p-HPhLA, and their sum, ∑3AMM), catecholamine metabolites (3,4-dihydroxymandelic [DHMA], 3,4-dihydroxyphenylacetic [DOPAC], and homovanillic [HVA] acids), lactate, N-terminal pro-brain natriuretic peptide (NT-proBNP), inducible nitric oxide synthase (iNOS), and procalcitonin (PCT) were compared. Correlations between AMM and clinical and laboratory data were calculated.. There were 20 patients in the septic shock group and 21 in the nonseptic shock group. On admission, the septic shock patients demonstrated significantly higher levels of PhLA (2.3 vs. 0.8 μmol/L), p-HPhAA (4.6 vs. 1.4 μmol/L), p-HPhLA (7.4 vs. 2.6 μmol/L), HVA, lactate, and significantly lower levels of iNOS. The next day, the two groups also showed significant differences in the levels of PCT and NT-proBNP. The correlation between ∑3AMM and presence of shock, levels of lactate, HVA, and NT-proBNP on admission was 0.44, 0.67, 0.57, and 0.38, respectively, and the correlation on the next day was 0.59, 0.73, 0.76, and 0.6, respectively (P < 0.01). These findings can be explained by the ability of AMM to reduce tyrosine hydroxylase activity, thus limiting the synthesis of catecholamines.. AMM are involved in the pathogenesis of septic shock.

Topics: 3,4-Dihydroxyphenylacetic Acid; Acetates; Aged; Female; Homovanillic Acid; Humans; Lactates; Male; Mandelic Acids; Middle Aged; Natriuretic Peptide, Brain; Nitric Oxide Synthase Type II; Peptide Fragments; Pneumonia; Shock, Septic

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

BACKGROUND We aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock. MATERIAL AND METHODS After achieving normovolemia and a mean arterial pressure of at least 65 mmHg, 38 septic shock patients with low cardiac output (left ventricular ejective fraction), LEVF £45%) were randomly divided into two groups: levosimendan dobutamine. Patients in the levosimendan and dobutamine groups were maintained with intravenous infusion of levosimendan (0.2 μg/kg/minute) and dobutamine (5 μg/kg/minute) for 24 hours respectively. During treatment we monitored hemodynamics and LVEF, and measured levels of heart-type fatty acid binding protein (HFABP), troponin I (TNI), and brain natriuretic peptide(BNP). In addition, the length of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, and 28-day mortality were compared between the two groups. RESULTS The levosimendan group and the dobutamine group were well matched with respect to age (years, 55.4 ± 1 7.5 versus 50.2 ± 13.6) and gender (males, 68.4% versus 57.9%). Levosimendan-treated patients had higher stroke volume index (SVI), cardiac index (CI), LVEF, and left ventricular stroke work index (LVSWI), and lower extravascular lung water index (EVLWI) compared to dobutamine-treated patients (p<0.05). HFABP, TNI, and BNP in the levosimendan group were less than in the dobutamine group (p<0.05). There was no difference in the mechanical ventilation time, length of stay in ICU and hospital, and 28-day mortality between the two groups. CONCLUSIONS Compared with dobutamine, levosimendan reduces biomarkers of myocardial injury and improves systemic hemodynamics in patients with septic shock. However, it does not reduce the days on mechanical ventilation, length of stay in ICU and hospital, or 28-day mortality.

Topics: Biomarkers; Demography; Dobutamine; Fatty Acid-Binding Proteins; Female; Hemodynamics; Humans; Hydrazones; Lactic Acid; Male; Middle Aged; Multivariate Analysis; Myocardium; Natriuretic Peptide, Brain; Pyridazines; Regression Analysis; Shock, Septic; Simendan; Troponin I; Ventricular Function, Left

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

The importance of cardiomyocyte damage during sepsis has been a recent subject of interest. The progression of sepsis results in the upregulation of proinflammatory cytokines, which act in concert to damage cardiomyocytes and produce cardiac contractile dysfunction. B-type natriuretic peptide (BNP) is a neurohormone released from the ventricles of the heart in response to myocardial dysfunction. The goal of this study was to examine the relationship between BNP levels and the severity of sepsis independent of congestive heart failure.. Prospective, nonrandomized control study.. University hospital.. Forty-nine patients were divided into 3 groups: 13 patients with septic shock, 18 with early sepsis, and 18 age-matched healthy control subjects. We excluded patients with septic shock who had comorbid conditions (congestive heart failure or renal failure); sepsis severity was determined using the Sequential Organ Failure Assessment scoring system. Patients with sepsis were followed up for 21 days.. Serum BNP levels, determined at the time of diagnosis of sepsis and on patient improvement or deterioration.. Patients with septic shock had significantly higher BNP levels on admission compared with the other 2 groups (P < .05). The BNP levels were not significantly elevated in patients with early sepsis. Plasma BNP levels for patients with septic shock were positively correlated with Sequential Organ Failure Assessment scores (r(2) = 0.74, P < .05) and prognosticated survival.. This study confirms the relationship between BNP level elevation and severity of sepsis independent of congestive heart failure. It also supports the utility of BNP level as a marker for mortality in septic shock.

Topics: Biomarkers; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Risk Assessment; Shock, Septic

To investigate N-terminal pro-brain natriuretic peptide (NT-proBNP) level as a prognostic factor and a marker of myocardial dysfunction in patients with septic shock.. Prospective observational study.. Intensive care unit.. A total of 39 patients diagnosed with septic shock and requiring mechanical ventilation.. Demographic, hemodynamic, respiratory, and biological data (notably NT-proBNP, lactate, and cardiac troponin I) were collected at inclusion and every 12 hrs. The independent factors for death were higher Sequential Organ Failure Assessment score in the 24-hr period after inclusion (odds ratio, 4.7; 95% confidence interval, 1.15-19.3) and the highest NT-proBNP level in the 24-hr period after inclusion (odds ratio, 1.12 per 1000 pg/mL increase; 95% confidence interval, 1.05-1.26). An NT-proBNP of >13,600 pg/mL predicted intensive care unit mortality with an accuracy of 77%. Area under the receiver operating characteristic curve was 0.8 (p = .002; 95% confidence interval, 0.66-0.93). NT-proBNP levels were over the accepted normal range in all patients. Values were highest between 24 and 36 hrs after onset of septic shock and were significantly higher in nonsurvivors at each time between inclusion and day 7. The lowest left ventricular stroke work index of the first 24-hr period after inclusion was the only factor that independently influenced higher NT-proBNP levels at the same time (odds ratio, 0.91; 95% confidence interval, 0.84-0.98).. NT-proBNP seems to be an early factor of prognosis and myocardial dysfunction in patients with septic shock.

Topics: Aged; Blood Pressure; Cardiomyopathies; Female; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Prognosis; Prospective Studies; Respiration, Artificial; ROC Curve; Shock, Septic; Troponin I

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 study aimed to examine the correlation between early brain natriuretic peptide (BNP) levels and mortality in cancer patients with septic shock.. A retrospective analysis of 159 cancer patients with septic shock admitted to the intensive care unit (ICU) from Dec. 2012 to Dec. 2019 was performed. BNP levels and other variables, including blood lactate (Lac), procalcitonin (PCT), white blood cell (WBC) counts, acute physiology and chronic health status system II scores (APACHE-II scores) were collected within 24 hours after ICU admission. According to 28-day mortality, patients were divided into a death group (60 cases) and a survival group (99 cases). All variables were compared by univariate analysis, and then a multiple logistic regression analysis was performed on the variables that showed significant differences. Receiver operating characteristic curve (ROC curve) analysis was used to evaluate the predictive value of BNP on mortality in cancer patients with septic shock.. BNP, APACHE-II score, Lac, and PCT in the death group were significantly higher than those in the survival group (P<0.05). Multiple logistic regression analysis of these four variables indicated that BNP, APACHE-II score and Lac were independent risk predictors of mortality in these patients (P<0.05). The BNP level at 899.6 pg/mL predicted mortality with a sensitivity of 76.7% and a specificity of 84.7%. The area under the ROC curve was 0.86±0.03 (P<0.05) for BNP, which was significantly larger than that of the APACHE-II score (P<0.05) and Lac (P<0.05).. BNP was an independent risk factor for mortality in cancer patients with septic shock, and had a higher predictive value than the APACHE-II score and Lac.

Topics: Humans; Natriuretic Peptide, Brain; Neoplasms; Prognosis; Retrospective Studies; Shock, Septic

To compare demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for COVID-19 in Brescia, Lombardy, Italy.. The study population includes 99 consecutive patients with COVID-19 pneumonia admitted to our hospital between 4 March and 25 March 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and non-cardiac patients except for higher values of serum creatinine, N-terminal probrain natriuretic peptide, and high sensitivity troponin T in cardiac patients. During hospitalization, 26% patients died, 15% developed thrombo-embolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank P = 0.019; relative risk 2.35; 95% confidence interval 1.08-5.09). The rate of thrombo-embolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively).. Hospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease, with higher mortality, thrombo-embolic events, and septic shock rates.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Betacoronavirus; Coronavirus Infections; COVID-19; Creatinine; Female; Heart Diseases; Heart Failure; Hospitalization; Humans; Italy; Male; Middle Aged; Natriuretic Peptide, Brain; Pandemics; Peptide Fragments; Pneumonia, Viral; Prognosis; Respiratory Distress Syndrome; Risk Factors; SARS-CoV-2; Shock, Septic; Thromboembolism; Troponin T

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

A 17-year-old obese male was admitted to the pediatric intensive care unit after presenting with fluid-responsive septic shock following 7 days of fever, gastrointestinal symptoms and neck pain. Initial workup was positive for SARS-CoV-2 and elevated troponin I and brain natriuretic peptide. Echocardiography and cardiac magnetic resonance imaging confirmed acute myocarditis. One week after discharge, repeat echocardiogram demonstrated improved heart function with only residual myocardial dysfunction.

Topics: Adolescent; Betacoronavirus; Coronavirus Infections; COVID-19; Echocardiography; Heart; Humans; Intensive Care Units; Magnetic Resonance Imaging; Male; Myocarditis; Natriuretic Peptide, Brain; New York City; Pandemics; Pneumonia, Viral; SARS-CoV-2; Shock, Septic

Biomarkers that can measure illness severity and predict the risk of delayed recovery may be useful in guiding pediatric septic shock. Amino-terminal pro-B-type natriuretic peptide has not been assessed in pediatric septic patients at the time of presentation to the emergency department prior to any interventions. The primary aim was to assess if emergency department amino-terminal pro-B-type natriuretic peptide is associated with worse outcomes and severity of illness.. Prospective observational pilot study.. Tertiary free-standing children's hospital.. Children 0-17 years old with a diagnosis of septic shock were enrolled. Patients with preexisting cardiac and renal dysfunction were excluded.. None.. Amino-terminal pro-B-type natriuretic peptide analysis was performed on samples obtained in the emergency department prior to any intervention. The association between biomarkers and clinical outcomes and illness severity using Pediatric RISk of Mortality 3 were assessed. Eighty-two patients with septic shock underwent analysis. The median (interquartile range) amino-terminal pro-B-type natriuretic peptide levels was 394 pg/mL (102-1,392 pg/mL). Each decile change increase in amino-terminal pro-B-type natriuretic peptide was associated with a change in ICU length of stay by 8.7%, (95% CI, 2.4-15.5), hospital length of stay by 5.7% (95% CI, 0.4-11.2), organ dysfunction by 5.1% (95% CI, 1.8-8.5), a higher inotropic score at 12, 24, and 36 hours, and longer time requiring vasoactive agents. There was a significant correlation between baseline amino-terminal pro-B-type natriuretic peptide and the Pediatric RISk of Mortality 3 score (Spearman rho = 0.247; p = 0.029).. This pilot study shows an association between emergency department amino-terminal pro-B-type natriuretic peptide on presentation and worse septic shock outcomes and amino-terminal pro-B-type natriuretic peptide levels correlates with an ICU severity score.

Topics: Biomarkers; Emergency Service, Hospital; Female; Hospitals, Pediatric; Humans; Intensive Care Units, Pediatric; Length of Stay; Male; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Prognosis; Prospective Studies; Severity of Illness Index; Shock, Septic; Tertiary Care Centers; Vasoconstrictor Agents

This study was performed to compare the predictive performance of serum procalcitonin (PCT), N-terminal brain natriuretic propeptide (NT-proBNP), interleukin-6 (IL-6), prothrombin time (PT), thrombin time (TT), and Sequential Organ Failure Assessment (SOFA) score in the intensive care unit (ICU).. This retrospective cohort study enrolled 150 patients with sepsis and septic shock and 30 control patients without sepsis. Each patient was followed until death or 28 days. Correlations between variables were assessed with Spearman's rho test. The Kruskal-Wallis and Mann-Whitney U tests were used for between-group comparisons.. Receiver operating characteristic curve analysis of the SOFA score, PCT, NT-proBNP, IL-6, PT, and TT showed an area under the curve of 0.872, 0.732, 0.711, 0.706, 0.806, and 0.691, respectively, for diagnosing sepsis. Binary logistic regression demonstrated that the SOFA score was an independent predictor of 28-day mortality and septic shock. The correlation coefficient (r) between SOFA and PCT, NT-proBNP and SOFA, IL-6 and SOFA, PT and SOFA, and TT and SOFA was 0.79, 0.52, 0.57, 0.56, and 0.58, respectively.. While the SOFA score is the gold standard, analysis of multiple biomarkers could increase the performance capacity for diagnosis and prognosis in patients with sepsis in the ICU.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Female; Humans; Intensive Care Units; Interleukin-6; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Peptide Fragments; Procalcitonin; Prognosis; Prothrombin Time; Retrospective Studies; ROC Curve; Shock, Septic; Survival Analysis; Thrombin Time

Topics: Child; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pilot Projects; Shock, Septic

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

This study is designed as prospective and observational research of patients with sepsis. It was carried out in the intensive care unit (ICU). We investigated the shape change index (SCI) of inferior vena cava (IVC) measured with trans-abdominal ultrasound to detect the signs of septic shock. The aim of this research was to find the most effective tool in predicting shock in patients compared with that of other parameters such as brain natriuretic peptide (BNP), lactate, variation index of inferior vena cava IVC-VI, and extravascular lung water index (EVLWI).. We suppose that SCI can be used as the safest and most sensitive tool in the early recognition of septic dysfunction. The observational study was conducted in the Department of ICU, Shandong Provincial Hospital Affiliated to Shandong University from January 2016 to December 2017. SCI of IVC, serum lactate, BNP, IVC-VI, and EVLWI concentrations were measured in 30 sepsis patients. All studied biomarkers were analyzed and contrasted according to the score of the Sequential Organ Failure Assessment (SOFA). Pearson correlation analysis was analyzed to statistic the relationship between variables.. We showed the correlation of BNP value, lactic acid value, IVC-VI, EVLWI, and SCI of IVC in sick patients suffering septic shock. Positive correlation was observed in the BNP value, lactic acid value, IVC-VI, EVLWI, and SCI of IVC (r=0.447, p=0.013; r=0.484, p=0.007; r=0.423, p=0.023; r=0.638, p<0.001; r=0.599, p<0.001; respectively). However, the SCI and EVLWI showed a stronger correlation with the SOFA than the others. SCI of IVC, as estimated by transabdominal ultrasound, was more accurate than the other commonly used non-invasive predictors. EVLWI, as an accurate and classical predictor, was an invasive predictor. SCI of IVC was faster, more convenient and safer than the other.. SCI of IVC was faster, more convenient and safer than the other commonly used non-invasive predictors. Early recognition and diagnosis of sepsis may improve patient outcome.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; China; Early Diagnosis; Extravascular Lung Water; Female; Humans; Intensive Care Units; Lactic Acid; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Sensitivity and Specificity; Shock, Septic; Ultrasonography; Vena Cava, Inferior; Young Adult

cardiac function in patients with septic shock at the cellular level can be assessed by measuring troponin I and NT Pro BNP levels. Venous oxygen saturation is measured to evaluate oxygen delivery and uptake by organ tissue. Our study may provide greater knowledge and understanding on pathophysiology of cardiovascular disorder in patients with septic shock. This study aimed to evaluate the roles of echocardiography, cardiovascular biomarkers, venous oxygen saturation and renal function as predictors of mortality rate in patients with septic shock.. this is a prospective cohort study in patients with infections, hypotension (MAP < 65 mmHg) and serum lactate level of > 2 mmol/L. On the first and fifth days, septic patients underwent echocardiography and blood tests. Statistical analysis used in our study included t-test or Mann-Whitney test for numeric data and chi-square test for nominal data of two-variable groups; while for multivariate analysis, we used Cox Regression model.. on 10 days of observation, we found 64 (58%) patients died and 47 (42%) patients survived. The mean age of patients was 48 (SD 18) years. Patients with abnormal left ventricular ejection fraction (LVEF) had 1.6 times greater risk of mortality than those with normal LVEF (RR 1.6; p = 0.034). Patients with abnormal troponin I level showed higher risk of mortality as many as 1.6 times (RR: 1.6; p = 0.004). Patients with impaired renal function had 1.5 times risk of mortality (RR 1.5; p = 0.024). Patients with abnormal troponin I level and/or impaired renal function showed increased mortality risk; however, those with normal troponin I level and impaired renal function also showed increased mortality risk. Multivariate analysis revealed that left ventricular ejection fraction and troponin I level may serve as predictors of mortality in patients with septic shock. (HR 1.99; 95% CI: 1.099  ̶  3.956 ; p = 0.047 and HR: 1.83 ; 95%CI: 1.049  ̶ 3,215 ; p = 0.043).. left ventricular ejection fraction and biomarkers such as troponin I level are predictors of mortality in septic shock patients.

Topics: Adult; Aged; Biomarkers; Creatinine; Echocardiography; Female; Heart; Humans; Indonesia; Kidney; Kidney Function Tests; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Oxygen; Peptide Fragments; Prognosis; Proportional Hazards Models; Prospective Studies; Shock, Septic; Troponin I; Ventricular Function, Left

To explore the correlation between major inflammatory factors and septic shock in intensive care unit (ICU) patients, and to provide a basis for the diagnosis and treatment of septic shock.. The patients admitted to ICU of the Third People's Hospital of Datong from March 2017 to August 2018 were selected as the research objects. According to the diagnostic criteria of septic shock, the patients were divided into septic shock group and non-septic group. The basic information and inflammatory factors levels of the two groups, including age, gender, body mass index (BMI), course of disease, acute physiology and chronic health evaluation II (APACHE II), infection site and pathogenic; and C-reactive protein (CRP), procalcitonin (PCT), neutrophil lymphocyte ratio (NLR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), interleukins (IL-1β, IL-2, IL-6, IL-8) at 8 hours after diagnosis, were compared. Logistic regression was used to analyze the influencing factors of septic shock in ICU patients.. A total of 154 ICU patients were selected, of whom 74 had septic shock. The APACHE II score of septic shock group was significantly higher than that of non-sepsis group (23.42±3.64 vs. 15.67±2.26, P < 0.05). There was no significant difference in other baseline data between the two groups. The levels of CRP, NT-proBNP, TNF-α, IFN-γ, PCT, IL-6, IL-8 in the septic shock group were significantly higher than those in the non-septic group [CRP (mg/L): 164.3±22.6 vs. 52.3±16.2, NT-proBNP (ng/L): 426.3±288.9 vs. 167.3±80.6, TNF-α (ng/L): 193.4±39.3 vs. 88.1±20.3, IFN-γ (ng/L): 133.3±52.0 vs. 97.0±56.1, PCT (ng/L): 27.6±10.2 vs. 7.3±4.1, IL-6 (ng/L): 83.0±17.6 vs. 20.9±6.4, IL-8 (ng/L): 445.8±34.0 vs. 84.0±25.7, all P < 0.05]. It was shown by Logistic regression analysis that CRP, NT-proBNP, TNF-α, PCT, IL-6 were independent risk factors for septic shock [CRP: odds ratio (OR) = 1.662, 95% confidence interval (95%CI) = 1.132-2.567; NT-proBNP: OR = 14.688, 95%CI = 3.580-20.238; TNF-α: OR = 1.093, 95%CI = 1.043-1.343; PCT: OR = 6.378, 95%CI = 4.556-12.243; IL-6: OR = 9.641, 95%CI = 2.242-13.786; all P < 0.05].. The levels of inflammatory factors CRP, NT-proBNP, TNF-α, PCT and IL-6 were significantly increased, which were important factors for early diagnosis of septic shock.

Topics: APACHE; C-Reactive Protein; Female; Humans; Intensive Care Units; Interleukin-6; Male; Natriuretic Peptide, Brain; Peptide Fragments; Procalcitonin; Shock, Septic; Tumor Necrosis Factor-alpha

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 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

We sought to evaluate the levels of intestinal fatty acid-binding protein (I-FABP), a biomarker of enterocyte injury, as a predictor of 28-day mortality and bowel ischemia in septic shock patients.. In this preliminary prospective observational study, 57 adult septic shock patients under mechanical ventilation were enrolled. Serum I-FABP levels and prognostic biomarkers were recorded upon intensive care unit (ICU) admission.. The overall 28-day mortality rate of participants was 23% (13/57). Non-survivors displayed significantly higher lactate (p=0.009), I-FABP (p=0.012), and N-terminal pro-B-type natriuretic peptide (p=0.039) levels compared to survivors. Only I-FABP was associated with 28-day mortality (odds ratio, 1.036; 95% confidence interval, 1.003-1.069; p=0.031) in a multiple logistic regression analysis adjusted for the Acute Physiology and Chronic Health Evaluation II score. When divided into low and high I-FABP groups based on the optimum cut-off value of 19.0ng/mL for predicting 28-day mortality, high-I-FABP patients had a significantly higher incidence of non-occlusive mesenteric ischemia (NOMI) (2% [1/43] vs 29% [4/14]; p=0.011).. I-FABP level at ICU admission can serve as a predictor of 28-day mortality in septic shock patients and is associated with the incidence of NOMI.

Topics: Aged; Biomarkers; Critical Care; Fatty Acid-Binding Proteins; Female; Humans; Lactic Acid; Male; Mesenteric Ischemia; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Prognosis; Prospective Studies; Respiration, Artificial; Shock, Septic

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

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

To investigate the influence of left ventricular-arterial coupling(VAC) on clinical prognosis of elderly patients with septic shock.. A total of 56 elderly septic shock patients were enrolled in this study, all of whom were admitted to Department of Intensive Care Unit in Zhejiang Hospital from August 2014 to October 2015.The patients were divided into two groups according to the status of left ventricular-arterial coupling when septic shock was diagnosed, which were left ventricular-arterial uncoupling group(UC group) and left ventricular-arterial coupling group(C group). Various parameters were recorded, including blood lactate level, central venous oxygen saturation(ScvO2), serum level of N-terminal pro-brain natriuretic peptide(NT-proBNP) and cardiac troponin Ⅰ(cTNⅠ), dose of vasoactive drugs, the total fluid volume and urine volume per hour within 24 hours. The 28-day survival rate was a key index of prognosis. Multivariate logistic regression was taken to analyze risk factors related to death within 28 day.. Compared with C group, UC group had lower values of left ventricular ejection fraction[(42.43±4.76)% vs (53.17±3.01)%; P<0.01] and cardiac index[(2.36±0.68) L·min(-1)·m(-2) vs (2.93±0.45)L·min(-1)·m(-2); P<0.01]. Yet serum levels of NT-proBNP[lg NT-proBNP 3.93±0.53 vs 3.40±0.63; P=0.004] and cTNⅠ [lg cTNⅠ-0.16±0.68 vs-1.03±0.69; P<0.001] in UC group were higher than those in C group. Moreover, the total fluid volume within 24 hours [(3 806.3±831.4) ml vs (3 142.0±770.0) ml; P=0.016], blood lactate level[(5.61±2.68) mmol/L vs (3.93±1.59) mmol/L; P=0.043] and dose of norepinephrine[(0.630±0.300)μg·kg(-1)·min(-1) vs (0.292±0.234)μg·kg(-1)·min(-1;) P=0.001] in UC group were greater than those in C group, while ScvO2[(60.75±2.91)% vs (64.42±2.19)%; P<0.001] and urine volume per hour[(0.518±0.358)ml vs (0.926±0.678)ml; P=0.007] were less than those in C group. Compared with C group, UC group had a lower 28-day survival rate[43.2%(19/44) vs 9/12; P=0.049]. Ea/Ees ratio was negatively correlated with LVEF, ScvO2(r=-0.686, P<0.001; r=-0.411, P=0.002), positively correlated with NT-proBNP, cTNⅠ(r=0.294, P=0.028; r=0.363, P=0.006), yet no obvious correlation was noticed with blood lactate level(r=0.170, P=0.21). Multiple logistic regression analysis showed that VAC(OR=11.187, 95%CI 2.489-50.285; P=0.002), lactate level (OR=1.727, 95%CI 1.164-2.563; P=0.007) and lg cTNⅠ(OR=0.247, 95%CI 0.079-0.779; P=0.017) were independent risk factors affecting 28-day mortality. Conclutions: In elderly patients with septic shock, left ventricular-arterial uncoupling indicates a lower 28-day survival rate, worse cardiac function and tissue perfusion. Ea/Ees ratio might sever as a predictive indicator of 28-day mortality.

Topics: Aged; Heart Ventricles; Humans; Intensive Care Units; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Shock, Septic; Survival Rate

To evaluate the prognostic value of combination of plasma brain natriuretic peptide(BNP) with the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity(E/E') in the patients with septic shock.. From June 2012 to December 2013 , 127 patients with septic shock were consecutively recruited and underwent trans-thoracic echocardiography examination within 6 h after admission to Intensive Care Unit(ICU), Zhejiang Provincial People's Hospital. Plasma BNP concentration was measured using ELISA method. All Clinical, laboratory, and survival data were prospectively collected.. Of 127 patients enrolled, mean values for age were(59.9±17.3) years and APACHE Ⅱ score(16.8±5.8), respectively. 95 patients(74.8%) took mechanical ventilation. 28- , 60-day mortality rate was 36.3% and 42.3%, respectively. Univariate Cox regression analysis showed that age, coronary artery disease, serum creatinine and lactate, plasma BNP, left ventricular ejection fraction(LVEF), E/E' and APACHE Ⅱ score were significantly(P≤0.05) associated with 60-day mortality. Multivariate analysis revealed that serum lactate, plasma BNP(χ(2)=9.4, P=0.002) , E/E'(χ(2)=4.89, P=0.02) and APACHE Ⅱ score(χ(2)=10.6, P=0.001) remained independent predictors for 60-day mortality. ROC curve analysis showed that the optimal plasma BNP and E/E' cutoff values identified were 338.8 pg/ml and 10.8, and the areas under ROC curve were 0.89(sensitivity: 83.7%; specificity: 81.4%)and 0.83(sensitivity: 76.7%; specificity: 72.9%)for 60-day mortality, respectively. In addition to plasma BNP and clinical predictors, the E/E' could provide in independent and incremental prognostic value of 60-day mortality(χ(2)=59.3 vs 47.8, P<0.001).. Plasma BNP and E/E' are independent predictors for 60-day mortality, and combination of plasma BNP and E/E' could improve risk stratification in patients with septic shock.

Topics: Cardiomyopathies; Echocardiography; Humans; Intensive Care Units; Middle Aged; Mitral Valve; Multivariate Analysis; Natriuretic Peptide, Brain; Prognosis; ROC Curve; Shock, Septic; Ventricular Function, Left

Given the high mortality rates in elderly patients with septic shock, the early recognition of patients at greatest risk of death is crucial for the implementation of early intervention strategies. Serum lactate and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels are often elevated in elderly patients with septic shock and are therefore important biomarkers of metabolic and cardiac dysfunction. We hypothesized that a risk stratification system that incorporates the Acute Physiology and Chronic Health Evaluation (APACHE) II score and lactate and NT-proBNP biomarkers would better predict mortality in geriatric patients with septic shock than the APACHE II score alone.. A single-center prospective study was conducted from January 2012 to December 2013 in a 30-bed intensive care unit of a triservice hospital. The lactate area score was defined as the sum of the area under the curve of serial lactate levels measured during the 24 hours following admission divided by 24. The NT-proBNP score was assigned based on NT-proBNP levels measured at admission. The combined score was calculated by adding the lactate area and NT-proBNP scores to the APACHE II score. Multivariate logistic regression analyses and receiver operating characteristic curves were used to evaluate which variables and scoring systems served as the best predictors of mortality in elderly septic patients.. A total of 115 patients with septic shock were included in the study. The overall 28-day mortality rate was 67.0%. When compared to survivors, nonsurvivors had significantly higher lactate area scores, NT-proBNP scores, APACHE II scores, and combined scores. In the multivariate regression model, the combined score, lactate area score, and mechanical ventilation were independent risk factors associated with death. Receiver operating characteristic curves indicated that the combined score had significantly greater predictive power when compared to the APACHE II score or the NT-proBNP score (P < .05).. A combined score that incorporates the APACHE II score with early lactate area and NT-proBNP levels is a useful method for risk stratification in geriatric patients with septic shock.

Topics: Aged; Aged, 80 and over; APACHE; Biomarkers; Female; Humans; Intensive Care Units; Lactic Acid; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Respiration, Artificial; ROC Curve; Shock, Septic

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

In vitro studies suggested that circulating inflammatory cytokines cause septic myocardial dysfunction. However, no in vivo clinical study has investigated whether serum inflammatory cytokine concentrations correlate with septic myocardial dysfunction.. Repeated echocardiograms and concurrent serum inflammatory cytokines (IL-1β, IL-6, IL-8, IL-10, IL-18, tumor necrosis factor-α, and monocyte chemoattractant protein-1) and cardiac biomarkers (high-sensitivity [hs] troponin-T and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) were examined in 105 patients with severe sepsis and septic shock. Cytokines and biomarkers were tested for correlations with systolic and diastolic dysfunction, sepsis severity, and mortality.. Systolic dysfunction defined as reduced left ventricular ejection fraction (LVEF) < 50% or < 55% and diastolic dysfunction defined as e'-wave < 8 cm/s on tissue-Doppler imaging (TDI) or E/e'-ratio were found in 13 (12%), 24 (23%), 53 (50%), and 26 (25%) patients, respectively. Forty-four patients (42%) died in-hospital. All cytokines, except IL-1, correlated with Sequential Organ Failure Assessment and APACHE (Acute Physiology and Chronic Health Evaluation) II scores, and all cytokines predicted mortality. IL-10 and IL-18 independently predicted mortality among cytokines (OR = 3.1 and 28.3, P = .006 and < 0.0001). However, none of the cytokines correlated with LVEF, end-diastolic volume index (EDVI), stroke-volume index (SVI), or s'-wave and e'-wave velocities on TDI (Pearson linear and Spearman rank [ρ] nonlinear correlations). Similarly, no differences were found in cytokine concentrations between patients dichotomized to high vs low LVEF, EDVI, SVI, s'-wave, or e'-wave (Mann-Whitney U tests). In contrast, NT-proBNP strongly correlated with both reduced LVEF and reduced e'-wave velocity, and hs-troponin-T correlated mainly with reduced e'-wave.. Unlike cardiac biomarkers, none of the measured inflammatory cytokines correlates with systolic or diastolic myocardial dysfunction in severe sepsis or septic shock.

Topics: Aged; Aged, 80 and over; Biomarkers; Chemokine CCL2; Cohort Studies; Female; Humans; Interleukins; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Shock, Septic; Stroke Volume; Troponin T; Tumor Necrosis Factor-alpha; Ultrasonography; Ventricular Dysfunction, Left

To investigate the value of employing pulse indicator continuous cardiac output ( PiCCO ) for cardiac function monitoring in patients with severe septic shock.. A prospective observation was conducted. Thirty-six septic shock patients in Department of Critical Care Medicine of Peking University Third Hospital admitted from August 2011 to December 2013 were enrolled. According to the degree of severity, the patients were divided into PiCCO monitor group and routine monitor group. The PiCCO monitor provided a continuous assessment of fluid resuscitation, vasopressors and inotropes infusion in the patients with severe septic shock. The following cardiac function parameters were assessed in severe septic shock patients on the 1st and 3rd day after intensive care unit ( ICU ) admission: cardiac index ( CI ), global ejection fraction ( GEF ), rate of left ventricular pressure increase ( dp/dt max ), echocardiography, and blood troponin T ( TNT ) and B-type natriuretic peptide ( BNP ). The central venous pressure ( CVP ), mean arterial pressure ( MAP ) and the time reaching their standard values, and the norepinephrine dosage and 3-day fluid balance in severe septic shock patients were compared between milrinone and non-milrinone usage groups. The severity degree and outcome were compared between PiCCO monitor group and routine monitor group.. There were 15 patients in PiCCO monitor group and 21 in routine monitor group among 36 septic shock patients. (1) In 15 patients with PiCCO monitoring, the patients with decreased CI, GEF, and dp/dt max accounted for 40.0%, 93.3%, and 33.3% at 1 day after ICU admission, and accounted for 60.0%, 93.3%, and 60.0% at 3 days after ICU admission, and it showed that CI, GEF, and dp/dt max was not improved at 3 days after ICU admission. Echocardiography showed that 35.7% patients had lower left ventricular ejection fraction ( LVEF ) at 1 day after ICU admission, 71.4% and 71.4% of patients, respectively, had lower early diastolic mitral flow velocity/early diastolic myocardial velocity ( E/Em ) and early diastolic mitral flow velocity/end diastolic mitral flow velocity ( E/A ). Three days after ICU admission, 80% of patients with low LVEF value turned to normal, and diastolic dysfunction was ameliorated in 50% patients. At 1 day after ICU admission, higher TNT was found in 92.9% of patients, higher BNP in 100% of patients, and 3 days after ICU admission, 71.4% and 78.6% patients showed a decrease in TNT and BNP, respectively. (2) In PiCCO monitor group, there were no significant differences in initial CVP, MAP and their time reaching standard values, norepinephrine dosage between milrinone group ( n = 8 ) and non-milrinone group ( n = 7 ). However, 3-day intake of liquid in milrinone group was significantly higher than that in non-milrinone group ( mL: 8 324±3 962 vs. 4 372±2 081, t = -2.362, P = 0.034 ). (3) Compared with routine monitor group, there was a significant elevation in acute physiology and chronic health evaluation II ( APACHEII) score, sequential organ failure assessment ( SOFA ) score, duration of mechanical ventilation, length of ICU stay and 28-day hospital mortality in PiCCO monitor group [ APACHEII score: 20.67±6.15 vs. 14.71±4.67, t = -3.304, P = 0.002; SOFA score: 9.53±3.00 vs. 7.52±1.97, t = -2.433, P = 0.020; duration of mechanical ventilation ( hours ): 132 ( 54-310 ) vs. 63 ( 14-284 ), Z = -2.295, P = 0.022; length of ICU stay ( days ): 7 ( 4-15 ) vs. 5 ( 1-14 ), Z = -2.360, P = 0.018; 28-day hospital mortality: 26.7% vs. 0, P = 0.023 ].. With the use of the PiCCO hemodynamic monitoring in patients with severe septic shock, more comprehensive values of blood volume, systemic vascular resistance and cardiac function can be obtained for guiding fluid resuscitation and selection of vasopressor and inotropic drugs.

Topics: Arterial Pressure; Cardiac Output; Central Venous Pressure; China; Echocardiography; Fluid Therapy; Humans; Intensive Care Units; Monitoring, Physiologic; Natriuretic Peptide, Brain; Prospective Studies; Shock, Septic; Vasoconstrictor Agents

The aim of this study was to evaluate the prognostic value of B-type natriuretic peptide (BNP) in combination with the sequential organ failure assessment (SOFA) score in patients with septic shock at the time of emergency department (ED).. Study subjects included all consecutive patients with septic shock who were treated with resuscitation bundle therapy between January 2010 and July 2012. SOFA scores and BNP were measured at ED recognition. The primary outcome was 28-day mortality. The area under the receiver operating characteristic curve was used to compare the predictive ability of SOFA score alone and in combination with BNP.. A total of 290 patients with septic shock admitted to ED were included. The BNP and SOFA score were higher in nonsurvival group compared with survival group (1,156.0 versus 469.1 pg/mL, P < 0.01; 9.9 versus 8.0, P < 0.01). In the receiver operating characteristic curves for predicting 28-day mortality, the area under the curves of SOFA score combined with BNP was 0.728 (95% confidence interval [CI]: 0.658-0.798) and SOFA score alone was 0.682 (95% CI: 0.610-0.755). Although the predictive ability of SOFA with BNP was statistically higher than that of SOFA alone (P = 0.02), it could not increase prognostic accuracy clinically significantly. SOFA with BNP was an independent predictor of 28-day mortality (odds ratio: 1.40, 95% CI: 1.15-1.71).. The combination of SOFA with BNP at the time of ED presentation may provide superior prognostic accuracy to the patients with septic shock. However, further studies need to validate the prognostic usefulness of SOFA with BNP.

Topics: Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Organ Dysfunction Scores; Predictive Value of Tests; Prognosis; Retrospective Studies; ROC Curve; Shock, Septic

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

NT-proBNP and BNP have been demonstrated to be prognostic markers in cardiac disease and sepsis. However, the prognostic value and the dynamic changes of BNP or NT-proBNP in trauma patients remain unclear. The present study was conducted to investigate the dynamic changes of NT-proBNP in patients with major trauma (injury severity score ≥16), determine whether NT-proBNP could be used as a simple index to predict mortality in major trauma patients.. This prospective observational study included 60 patients with major trauma. Serum NT-proBNP levels were measured on the 1st, 3rd and 7th day after injury The NT-proBNP levels in survivors were compared with those in non-survivors. The efficacy of NT-proBNP to predict survival was analyzed using receiver operating characteristic curves. An analysis of correlations between NT-proBNP and various factors, including injury severity score, Glasgow coma score, acute physiology and chronic health evaluation II, central venous pressure, creatine kinase-MB, cardiac troponin I and procalcitonin (PCT) was performed. NT-proBNP levels in patients with traumatic brain injury were compared with those in patients without traumatic brain injury. A comparison of NT-proBNP levels between patients with and without sepsis was also performed at each time point.. NT-proBNP levels in non-survivors were significantly higher than those in survivors at all the indicated time points. In the group of non-survivors, NT-proBNP levels on the 7th day were markedly higher than those on the 1st day. In contrast, NT-proBNP levels in survivors showed a reduction over time. The efficacy of NT-proBNP to predict survival was analyzed using ROC curves, and there was no difference in the area under the ROC between NT-proBNP and APACHE II/ISS at the three time points. A significant correlation was found between NT-proBNP and ISS on the 1st day, NT-proBNP and CK-MB, Tn-I and APACHE II on the 3rd day, NT-proBNP and PCT on the 7th day. There were no significant differences in NT-proBNP levels between patients with or without brain trauma at all the indicated time points. NT-proBNP levels in patients with sepsis were significantly higher than those in patients without sepsis at all the indicated time points.. These findings suggest that dynamic detection of serum NT-proBNP might help to predict death in patients with major trauma. A high level of NT-proBNP at admission or maintained for several days after trauma indicates poor survival.

Topics: Adult; Aged; Biomarkers; Female; Follow-Up Studies; Humans; Lactic Acid; Male; Middle Aged; Multiple Trauma; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; Shock, Septic

Early assessment and aggressive hemodynamic treatment have been shown to increase the survival of patients in septic shock. Current and past sepsis guidelines recommend a resuscitation protocol including central venous pressure (CVP), mean arterial blood pressure (MAP), urine output and central venous oxygen saturation (ScvO2) for resuscitation within the first six hours. Currently, the established severity score systems like APACHE II score, SOFA score or SAPS II score predict the outcome of critically ill patients on the bases of variables obtained only after the first 24 hours. The present study aims to evaluate the risk of short-term mortality for patients with septic shock by the earliest possible assessment of hemodynamic parameters and cardiac biomarkers as well as their role for the prediction of the adverse outcome.. 52 consecutive patients treated for septic shock in the intensive care unit of one centre (Marien Hospital Herne, Ruhr University Bochum, Germany) were prospectively enrolled in this study. Hemodynamic parameters (MAP, CVP, ScvO2, left ventricular ejection fraction, Hematocrit) and cardiac biomarkers (Troponin I) at the ICU admission were evaluated in regard to their influence on mortality. The primary endpoint was all-cause mortality within 28 days after the admission.. A total of 52 patients (31 male, 21 female) with a mean age of 71.4±8.5 years and a mean APACHE II score of 37.0±7.6 were enrolled in the study. 28 patients reached the primary endpoint (mortality 54%). Patients presenting with hypotension (MAP <65 mmHg) at ICU admission had significantly higher rates of 28-day mortality as compared with the group of patients without hypotension (28-day mortality rate 74 % vs. 32 %, p<0.01). Furthermore, the patients in the hypotension present group had significantly higher lactate concentration (p=0.002), higher serum creatinin (p=0.04), higher NTproBNP (p=0.03) and after the first 24 hours higher APACHE II scores (p=0.04). A MAP <65 mmHg was the only hemodynamic parameter significantly predicting the primary endpoint (OR: 4.1, CI: 1.1 - 14.8, p=0.008), whereas the remaining hemodynamic variables CVP, ScvO2, Hematocrit, Troponin I and left ventricular ejection fraction (LVEF) seemed to have no influence on survival. Besides, non-survivors had a significantly higher age (74.1±9.0 vs. 68.4±6.9, p=0.01). If hypotension coincided with an age ≥72 years, the 28-day mortality rate escalated to 88%.. In our study, we identified a risk group with an exceedingly high mortality rate: the patients with an age ≥72 years and presenting with hypotension (MAP <65 mmHg). These data can be easily obtained at the time of the very first patient contact. As a result, an aggressive and a more effective treatment can be initiated within the first minutes of the primary care, possibly reducing organ failure and short-term mortality in this risk group.

Topics: Aged; Biomarkers; Blood Pressure; Echocardiography; Female; Heart; Hemodynamics; Humans; Hypotension; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Point-of-Care Testing; Predictive Value of Tests; Prospective Studies; Shock, Septic; Survival Rate; Troponin I

The aim of this study was to determine the role of NT-proBNP in predicting the outcome of septic patients and to evaluate possible correlations between NT-ProBNP and haemodynamics in sepsis.. Forty consecutive patients with severe sepsis were prospectively evaluated. Patients were treated with the gold standard therapy for sepsis. NT-BNP levels, endotoxin activity (EA), SOFA score and SAPS II score, cardiac index (CI), mean arterial pressure (MAP) and pulmonary arterial pressure (PAP) were evaluated at admission and after 72 hours. Survival was evaluated at 28 days after admission.. At 4-week follow-up, 22 patients had died (55%). Survival was not associated with age, gender, baseline EA and treatment, while it was associated with NT-proBNP levels at admission and after 72 hours. NT-proBNP>1,000 pg/ml at 72 hours was a robust independent predictor of survival. The area under the curve (AUC) of NT-proBNP at admission was 0.73 and 0.99 after 72 hours. At 72 hours, AUC for SOFA score was 0.94, for SAPS II score 1, for EA 0.73. Levels of NT-proBNP>1,000 pg/ml at 72 hours were associated with an adverse outcome (sensitivity 95.5%, specificity 94.4%). NT-proBNP at 72 hours correlated with CI, MAP and PAP (P<0.01, <0.01,<0.05 respectively).. Increased NT-proBNP levels at 72 hours could predict mortality at 28 days in patients with septic shock and are correlated with haemodynamics.

Topics: Aged; Area Under Curve; Biomarkers; Female; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; ROC Curve; Severity of Illness Index; Shock, Septic; Survival Analysis; Time Factors; Up-Regulation

To evaluate and explore the relationship among the pulmonary artery pressure, Brain natriuretic peptide and the prognosis in the patients with septic shock.. From May 2013 to Oct. 2014, 48 patients were treated with Swan-Ganz catheter to monitor the pulmonary artery pressure, the pulmonary vascular resistance, the pulmonary capillary wedge pressure and cardiac output. Testing brain natriuretic peptide, Analysising the differences between survival patients (27 cases) and dead patients (21 cases) in the PAP, PVR, PCWP, CO and BNP, Analysising the correlation between BNP and PAP, PVR, PCWP, CO by Linear correlation analysis.. It is no difference in hemodynamic parameters between dead patients and survival patients when they come in the hospital (P > 0.05); it is significant difference in hemodynamic parameters between dead patients and survival patients when they came in the hospital after 48 hours or 72 hours [(20.8 ± 5.8) mmHg vs (34.2 ± 7.4) mmHg, P < 0.05], it is no difference in PVR, PCWR and CO at 24 hours, 48 hours or 72 hours. Then it is significant difference in BNP between dead patients and survival patients that they had been entered the hospital after 48 hours or 72 hours [(286.5 ± 75.5) pg/ml vs (675.4 ± 51.3) pg/ml, P < 0.05], it has no obvious correlation among the BNP, PAP and CO.. It prompts a poor prognosis if the patients with septic shock had increased the pulmonary artery pressure and the BNP. Therefore it is need focus on pulmonary hypertension, it is different if BNP of plasma in heart failure patients increased, it does not mean heart function failuring, so it can not be used to give a guide to therapy on heart function.

Topics: Cardiac Output; Heart Failure; Hemodynamics; Humans; Hypertension, Pulmonary; Natriuretic Peptide, Brain; Prognosis; Pulmonary Artery; Pulmonary Wedge Pressure; Shock, Septic; Vascular Resistance

We aimed to investigate whether nuclear factor kappa-B activation, as evaluated by gene expression of its inhibitor (I-κBα) and cytokine serum levels, was associated with myocardial dysfunction and mortality in children with septic shock. Twenty children with septic shock were prospectively enrolled and grouped according to ejection fraction (EF) <45% (group 1) or EF ≥45% (group 2) on the first day after admission to the pediatric intensive care unit. No interventions were made. In the first day, patients from group 1 (n = 6) exhibited significantly greater tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-10 plasma levels. However, I-κBα gene expression was not different in both groups. Mortality and number of complications were significantly greater in group 1. Patients who died had greater plasma concentrations of TNF-α. In conclusion, TNF-α and IL-10 are involved in myocardial dysfunction accompanying septic shock in children, and TNF-α is associated with mortality.

Topics: Adolescent; Biomarkers; Cardiomyopathies; Child; Child, Preschool; Echocardiography; Enzyme-Linked Immunosorbent Assay; Female; Hemodynamics; Humans; Infant; Inflammation; Intensive Care Units, Pediatric; Interleukin-10; Longitudinal Studies; Male; Natriuretic Peptide, Brain; NF-kappa B; Prospective Studies; Shock, Septic; Tumor Necrosis Factor-alpha

To explore the effects of high volume hemofiltration (HVHF) on inflammatory factors, extra vascular lung water and alveolar-arterial oxygen exchange in patients with septic shock.. The data of 87 patients with septic shock underwent fluid resuscitation admitted to intensive care unit (ICU) of Shandong Provincial Hospital Affiliated to Shandong University were retrospectively analyzed. According to whether HVHF was used or not, all the patients were divided into fluid resuscitation group (n=41) and HVHF group (n=46). The patients in HVHF group received bedside high volume continuous vein-vein hemofiltration for at least 3 days on the basis of fluid resuscitation. The inflammatory factors, indexes of heart function, hemodynamics monitored by pulse-indicated continuous cardiac output (PiCCO), oxygen exchange, the severity of the disease before and after treatment, and 28-day mortality were compared between the two groups. The relationship between extra-vascular lung water index (EVLWI) and alveolar-arterial oxygen pressure difference (P(A-a)DO₂) was analyzed.. (1) After treatment, the serum levels of interleukin-6 (IL-6), procalcitonin (PCT), and N-terminal pro-B-type natriuretic peptide (NT(-pro)BNP) in both group were gradually decreased. The IL-6, PCT, and NT(-pro)BNP on the 3rd day after treatment in HVHF group were significantly lower than those in fluid resuscitation group [IL-6 (μg/L): 34.8 ± 15.8 vs. 63.3 ± 21.2, PCT (μg/L): 7.5 ± 6.4 vs. 17.3 ± 11.2, NT(-pro)BNP (μg/L): 561.8 ± 23.7 vs. 584.3 ± 56.7, P<0.05 or P<0.01]. (2) The hemodynamics indexes were improved after treatment in both groups. The levels of intrathoracic blood volume index (ITBVI), EVLWI and pulmonary vascular permeability index (PVPI) on the 3rd day after treatment in HVHF group were significantly lower than those in fluid resuscitation group [ITBVI (mL/m²): 634.2 ± 125.8 vs. 963.8 ± 321.0, EVLWI (mL/kg): 7.5 ± 2.4 vs. 12.3 ± 4.2, PVPI: 2.2 ± 1.2 vs. 4.2 ± 2.0, all P<0.01]. (3) The levels of PA-aDO₂and arterial blood lactic (Lac) were gradually decreased, and oxygenation index (PaO₂/FiO₂) was gradually increased in both groups. Compared with fluid resuscitation group, the P(A-a)DO₂and Lac on the 3rd and the 7th day were significantly declined[P(A-a)DO₂(mmHg, 1 mmHg=0.133 kPa) on the 3rd day: 252.37 ± 29.45 vs. 270.82 ± 38.07, on the 7th day: 181.08 ± 21.81 vs. 221.02 ± 29.13; Lac (mmol/L) on the 3rd day: 3.17 ± 2.03 vs. 4.07 ± 2.43, on the 7th day: 1.95 ± 0.97 vs. 2.45 ± 1.07, P<0.05 or P<0.01], and the PaO₂/FiO₂on the 7th day was significantly elevated (mmHg: 258 ± 41 vs. 178 ± 34, P<0.01). (4) A significant positive correlation was found between EVLWI and P(A-a)DO₂(r=0.693, P=0.001), with the 95% confident interval (95% CI) 0.617-0.773. (5) The condition was improved after treatment in the two groups. The acute physiology and chronic health evaluationII (APACHEII) scores and sepsis-related organ failure assessment (SOFA) scores on the 7th day after treatment in HVHF group were significantly reduced compared with those in fluid resuscitation group (APACHEII score on the 3rd day: 18.2 ± 7.7 vs. 22.4 ± 8.6, on the 7th day: 8.2 ± 3.8 vs. 17.2 ± 6.8; SOFA score on the 3rd day: 13.6 ± 3.4 vs. 15.8 ± 5.0, on the 7th day: 7.6 ± 3.3 vs. 12.8 ± 3.9, P<0.05 or P<0.01). The 28-day mortality in HVHF group was significantly lower than that in fluid resuscitation group [15.22% (7/46) vs. 34.15% (14/41), χ² = 4.242, P=0.038].. HVHF could decrease blood inflammatory factors, and reduce the vaso-permeability and extra vascular lung water with a result of the improvement of the levels of alveolar- arterial oxygen exchange in patients with septic shock and the prognosis at the same time.

Topics: Capillary Permeability; Extravascular Lung Water; Fluid Therapy; Hemodynamics; Hemofiltration; Humans; Intensive Care Units; Interleukin-6; Lung; Monitoring, Physiologic; Natriuretic Peptide, Brain; Oxygen; Peptide Fragments; Retrospective Studies; Shock, Septic

To investigate the predictive value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in the evaluation of prognosis and the severity of patients with septic shock induced myocardial suppression.. A prospective study was conducted, with enrollment of 102 patients with septic shock in intensive care unit (ICU) of Beijing Shijitan Hospital from August 2009 to August 2011. Plasma NT-pro-BNP levels were measured on the 1st, 3rd and 5th day after admission, and the acute physiology and chronic health evaluationII (APACHEII) score, sequential organ failure assessment (SOFA) score were monitored at admission to ICU. With the 28-day mortality after admission to ICU as the standard, the patients with septic shock were divided into the survivor group and non-survivor group. Dynamic changes in plasma NT-proBNP levels and score of APACHEII and SOFA were compared between two groups. The patients were divided into non-cardiac dysfunction group [cardiac index (CI)>50.0 ml×s(-1)×m(-2)] and cardiac dysfunction group (CI<50.0 ml×s(-1)×m(-2)) according to levels of CI after admission 24 hours. The level of plasma NT-proBNP was compared between two groups. The predictive value of plasma NT-proBNP on 28-day mortality was evaluated by multivariate logistic regression analysis.. (1)APACHEII score, SOFA score and plasma NT-proBNP levels in non-survivor group (n=45) were higher than those of survivor group (n=57, 1-day APACHEII score: 23.8±0.6 vs. 14.3±0.3, 1-day SOFA score: 12.4±3.0 vs. 7.7±2.8; NT-proBNP 1 day: 4.13±1.05 μg/L vs. 1.65±0.26 μg/L, 3 days: 5.32±0.93 μg/L vs. 1.87±0.29 μg/L, 5 days: 6.90±1.33 μg/L vs. 1.23±0.19 μg/L, P<0.05 or P<0.01). (2)Plasma NT-proBNP levels in cardiac dysfunction group (n=47) were higher than those of non-cardiac dysfunction group (n=55), and elevated obviously in non-survivors than those in survivors. (3)In multivariate logistic regression analysis, NT-proBNP level and APACHEII score were independent predictors of 28-day mortality (P<0.05 or P<0.01).. Plasma NT-proBNP levels show obvious significance in evaluation of prognosis and the severity of patients with septic shock induced myocardial depression. Plasma NT-proBNP level and APACHEII score are independent prognostic markers of mortality and sepsis-induced myocardial depression in septic shock.

Topics: Adult; Aged; Aged, 80 and over; Female; Heart; Humans; Logistic Models; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Shock, Septic; Young Adult

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

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

Previous studies of patients with septic shock have independently demonstrated alterations in plasma concentrations of B-type natriuretic peptide and plasma free cortisol. Previous data suggest that a reciprocal relationship might exist. However, the relationship between these hormones in patients with septic shock is unclear. We sought to compare paired measurement of both B-type natriuretic peptide and plasma free cortisol in a study of septic shock patients. Twenty-one consecutive adult patients from a tertiary level, multidisciplinary intensive care unit underwent blood collection within 72 hours of developing septic shock. Mean ± SD Acute Physiology and Chronic Health Evaluation III score was 80.1 ± 23.8. Hospital mortality was 29%. Log plasma free cortisol demonstrated positive correlation with log B-type natriuretic peptide (r=0.55, P=0.019). Log plasma free cortisol also correlated with Acute Physiology and Chronic Health Evaluation III score (r=0.67, P <0.001) and noradrenaline dose (r=0.55, P=0.01). Acute Physiology and Chronic Health Evaluation III (P=0.001) and noradrenaline dose (P=0.02) were independent predictors of plasma free cortisol. A model incorporating both variables explained 68% of variation in plasma free cortisol (R-square=0.682). This study of patients with septic shock demonstrates a previously unappreciated positive correlation between plasma free cortisol and b-type natriuretic peptide concentration. Acute Physiology and Chronic Health Evaluation III score and noradrenaline dose were independent predictors of plasma free cortisol.

Topics: Adrenergic alpha-Agonists; Aged; Aged, 80 and over; APACHE; Dose-Response Relationship, Drug; Hospital Mortality; Humans; Hydrocortisone; Intensive Care Units; Middle Aged; Models, Biological; Natriuretic Peptide, Brain; Norepinephrine; Severity of Illness Index; Shock, Septic

Amino-terminal pro-brain-type natriuretic peptide is known to predict outcome in patients with heart failure, but its role in an intensive care setting is not yet fully established.. To assess the incidence of elevated amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) on admission to intensive care and its relation to death in the ICU and within 30 days.. Prospective, observational cohort study.. A mixed non-cardiothoracic tertiary ICU in Sweden.. NT-pro-BNP was collected from 481 consecutive patients on admission to intensive care, in addition to data on patient characteristics and outcome. A receiver-operating characteristic curve was used to identify a discriminatory level of significance, a stepwise logistic regression analysis to correct for other clinical factors and a Kaplan-Meier analysis to assess survival. The correlation between Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment score (SOFA) and NT-pro-BNP was analysed using Spearman's correlation test. Quartiles of NT-pro-BNP elevation were compared for baseline data and outcome using a logistic regression model.. An NT-pro-BNP more than 1380 ng -l on admission was an independent predictor of death in the ICU and within 30 days [odds ratio (OR) 2.6; 95% confidence interval (CI), 1.5 to 4.4] and was present in 44% of patients. Thirty-three percent of patients with NT-pro-BNP more than 1380 ng -1, and 14.6% of patients below that threshold died within 30 days (log rank P=0.005). NT-pro-BNP correlated moderately with SAPS 3 and with SOFA on admission (Spearman's ρ 0.5552 and 0.5129, respectively). In quartiles of NT-pro-BNP elevation on admission, severity of illness and mortality increased significantly (30-day mortality 36.1%; OR 3.9; 95% CI, 2.0 to 7.3 in the quartile with the highest values, vs. 12.8% in the lowest quartile).. We conclude that NT-pro-BNP is commonly elevated on admission to intensive care, that it increases with severity of illness and that it is an independent predictor of mortality.

Topics: Adult; Aged; Biomarkers; Critical Care; Data Interpretation, Statistical; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; Respiration, Artificial; Retrospective Studies; ROC Curve; Shock, Septic; Survival Analysis; Treatment Outcome

We investigated the prognostic utility of changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) in combination with Sequential Organ Failure Assessment (SOFA) score in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) concomitant with septic shock. Forty-nine mechanically ventilated patients with ALI/ARDS concomitant with septic shock were studied. N-terminal pro-brain natriuretic peptide levels were measured on the first 3 days (days 0, 1, and 2) in the intensive care unit. The median NT-proBNP levels in survivors and nonsurvivors were 3,999 vs. 2,819 pg/mL on day 0 (P = 0.719); 4,495 vs. 5,397 pg/mL on day 1 (P = 0.543); and 2,325 vs. 14,173 pg/mL on day 2 (P = 0.028). N-terminal pro-brain natriuretic peptide levels increased significantly from baseline values in nonsurvivors only. We observed a monotonic increase in 28-day mortality associated with increasing quartiles of percent change in NT-proBNP on day 2 (P < 0.0001). Kaplan-Meier survival analysis revealed that mortality was significantly higher in patients with a change in NT-proBNP of 30% or more (log-rank P < 0.0001). On day 2, areas under the receiver operating characteristic curves for predicting 28-day mortality were 0.74 for SOFA alone and 0.85 (P = 0.028) for SOFA combined with percent change in NT-proBNP. In conclusion, in patients with ALI/ARDS concomitant with septic shock, a rising trend (high percent change) in NT-proBNP levels had better prognostic utility than absolute levels. The combination of percent change in NT-proBNP with SOFA may provide superior prognostic accuracy to SOFA alone.

Topics: Acute Lung Injury; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Respiratory Distress Syndrome; Shock, Septic

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

To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with severe sepsis and septic shock.. In a prospective study, clinical data of 50 patients with severe sepsis and septic shock were analyzed. Plasma NT-proBNP level was measured at 0, 24, 48 and 72 hours after admission to the intensive care unit (ICU) of a university hospital. Patients were divided into survival group and non-survival group according to 30-day mortality rate. The dynamic variation of plasma NT-proBNP level was observed and the difference of plasma NT-proBNP levels between two groups was compared. The predictive value of NT-proBNP on mortality was evaluated by receiver operating characteristic (ROC) curves. The potential confounding factors on NT-proBNP were assessed with linear regression analysis.. NT-proBNP levels (μg/L)at 0 hour after admission to ICU [20.86(14.28,23.92)] were significantly higher in non-survival group (n=20) compared with survival group [ n=30, 10.02 (5.58, 16.41), P<0.01], and the difference persisted to 72 hours [19.68 (13.90, 24.02) vs. 9.24 (4.30, 11.81), P<0.01], but there was no statistical difference of NT-proBNP levels among four time points. In the ROC curves for NT-proBNP at admission, the area under the curve(AUC) for hospital mortality was 0.842, and 95% confidence interval (CI) was 0.764-0.922, P<0.01. NT-proBNP greater than 13.30 μg/L at admission was an independent indicator of mortality (sensitivity 80.6%, specificity 70.2%). Linear regression analysis revealed that the oxygenation index (PaO(2)/FiO(2), r=-0.839, P=0.003), platelet count (PLT, r=-0.803, P=0.032), and sequential organ failure assessment (SOFA) scores at 0 hour after admission to ICU (r=0.874, P<0.001) had independent effects on NT-proBNP values at admission.. Plasma NT-proBNP level is a valuable prognostic factor for severe sepsis and septic shock patients.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Shock, Septic

Diastolic dysfunction as demonstrated by tissue Doppler imaging (TDI), particularly E/e' (peak early diastolic transmitral/peak early diastolic mitral annular velocity) is common in critical illness. In septic shock, the prognostic value of TDI is undefined. This study sought to evaluate and compare the prognostic significance of TDI and cardiac biomarkers (B-type natriuretic peptide (BNP); N-terminal proBNP (NTproBNP); troponin T (TnT)) in septic shock. The contribution of fluid management and diastolic dysfunction to elevation of BNP was also evaluated.. Twenty-one consecutive adult patients from a multidisciplinary intensive care unit underwent transthoracic echocardiography and blood collection within 72 hours of developing septic shock.. Mean +/- SD APACHE III score was 80.1 +/- 23.8. Hospital mortality was 29%. E/e' was significantly higher in hospital non-survivors (15.32 +/- 2.74, survivors 9.05 +/- 2.75; P = 0.0002). Area under ROC curves were E/e' 0.94, TnT 0.86, BNP 0.78 and NTproBNP 0.67. An E/e' threshold of 14.5 offered 100% sensitivity and 83% specificity. Adjustment for APACHE III, cardiac disease, fluid balance and grade of diastolic function, demonstrated E/e' as an independent predictor of hospital mortality (P = 0.019). Multiple linear regression incorporating APACHE III, gender, cardiac disease, fluid balance, noradrenaline dose, C reactive protein, ejection fraction and diastolic dysfunction yielded APACHE III (P = 0.033), fluid balance (P = 0.001) and diastolic dysfunction (P = 0.009) as independent predictors of BNP concentration.. E/e' is an independent predictor of hospital survival in septic shock. It offers better discrimination between survivors and non-survivors than cardiac biomarkers. Fluid balance and diastolic dysfunction were independent predictors of BNP concentration in septic shock.

Topics: Adult; Aged; Aged, 80 and over; APACHE; Biomarkers; Echocardiography, Doppler; Female; Forecasting; Heart; Heart Ventricles; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Peptide Fragments; Proportional Hazards Models; Prospective Studies; Shock, Septic; Survival Analysis; Troponin T; Ventricular Dysfunction; Young Adult

Aortic corrected flow time (FTc) is easily measured by Doppler techniques. Recent data using transoesophageal Doppler suggest that it may predict fluid responsiveness in critical care. This use of FTc has not previously been evaluated in septic shock, nor have any studies incorporated transcutaneously measured FTc. Furthermore, no comparison has been made between FTc, plasma B-type natriuretic peptide concentration (BNP) or central venous pressure. The aim of this preliminary study was to compare FTc, BNP and central venous pressure as predictors of fluid responsiveness in septic shock patients without cardiac dysrhythmia. This was a prospective study of 10 consecutive adult septic shock patients (in sinus rhythm; 60% mechanically ventilated) treated with intravenous fluid challenge (4% albumin 250 ml over 15 minutes) in a mixed medical/ surgical tertiary intensive care unit. Mean + SD Acute Physiological and Chronic Health Evaluation II score was 21.8 +/- 12.7. Haemodynamic assessment incorporating transcutaneous aortic Doppler (USCOM) occurred before and five minutes after fluid challenge. Concurrent with initial assessment, blood samples were collected for BNP assay (ADIVA Centaur). Four patients demonstrated an increase in stroke volume > or = 15% (responders). Percent change in stroke volume strongly correlated with baseline FTc (r = -0.81, P = 0.004) but not BNP (r = -0.3, P = 0.4) or central venous pressure (r = -0.4, P = 0.2). Baseline FTc < 350 ms discriminated responders from non-responders (P = 0.047). Our data support FTc as a better predictor of fluid responsiveness than either BNP or central venous pressure in septic shock. Transcutaneous aortic Doppler FTc offers promise as a simple, completely non-invasive predictor of fluid responsiveness and should be evaluated further

Topics: Adult; Aged; Aged, 80 and over; Central Venous Pressure; Female; Fluid Therapy; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Shock, Septic; Stroke Volume; Ultrasonography, Doppler

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

High B-type natriuretic peptide (BNP) levels are reported in the context of septic shock. We hypothesized that high BNP levels might be related to an alteration in BNP clearance pathway, namely neutral endopeptidase (NEP) 24.11. NEP 24.11 activity was measured in septic shock and in cardiogenic shock patients. We further evaluated whether baseline plasma BNP can predict fluid responsiveness and whether BNP can still be released in plasma despite high initial BNP levels, in response to overloading.. Prospective observational study. Patients in severe sepsis (S) or in septic shock (SS) needing a fluid challenge were included. Stroke volume (SV) and BNP were measured before (SV1, BNP1) and 45 mins after (SV2, BNP2) a standardized fluid challenge. DeltaBNP was defined as the difference between BNP2 and BNP1. NEP 24.11 activity was determined by fluorometry in 12 SS and 4 S patients before fluid challenge and in 5 cardiogenic shock patients.. Twenty-three patients (61 +/- 18 years old, Simplified Acute Physiology Score II: 54 +/- 21; 19 SS, 4 S; BNP1: 1371 +/- 1434 pg/mL) were studied. BNP1 concentrations were significantly higher in SS than in S (1643 +/- 1437 vs. 80 +/- 35 pg/mL; p = 0.002). There was no correlation between baseline BNP and fluid responsiveness. Nine of the 11 patients with BNP1 >1000 pg/mL were fluid responders. DeltaBNP was greater in fluid nonresponders than in fluid responders (22 +/- 27% vs. 6 +/- 11%, p = 0.028). Plasma BNP was higher in SS than in cardiogenic shock patients (1367 +/- 1438 vs. 750 +/- 346 respectively; p = 0.027). NEP 24.11 activity was lower in SS than in S patients (0.10 +/- 0.06 nmole/mL/min vs. 0.50 +/- 0.22 nmole/mL/min, p <0.0001) cardiogenic shock patients (0.10 +/- 0.06 nmole/mL/min vs. 0.58 +/- 0.19 nmole/mL/min; p = 0.002).. High levels of BNP might be related to an alteration in BNP clearance. During sepsis, high BNP levels are not predictive of fluid nonresponsiveness. Nevertheless, in fluid nonresponders, acute ventricular stretching can result in further BNP release.

Topics: Biomarkers; Demography; Female; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Severity of Illness Index; Shock, Septic

1) To compare brain natriuretic peptide levels in pediatric patients with septic shock with both children admitted to the pediatric intensive care unit without infection and with healthy subjects; and 2) to evaluate the correlation between brain natriuretic peptide with severity of illness and with myocardial dysfunction in children with septic shock.. : Prospective, observational study.. Children's Hospital pediatric intensive care unit.. Children from age 2 wks to 18 yrs. Thirteen children with septic shock requiring inotropic support, 12 healthy controls, and five critically ill patients without infection or heart disease were evaluated.. For patients with septic shock, brain natriuretic peptide was measured within 6 hrs of admission and throughout the pediatric intensive care unit course. Echocardiograms were performed within 12 hrs of admission and then repeated if the patient continued to require inotropic support. For controls, one measurement was performed.. Children with septic shock had an elevated (p < 0.0001) brain natriuretic peptide on admission (median 115 pg/mL [range 26-2960]) when compared with healthy (9 pg/mL [5-30]) and pediatric intensive care unit controls (10 pg/mL [5-30]). In patients with septic shock, brain natriuretic peptide at 12 hrs correlated directly with Pediatric Risk of Mortality III score (rs = .80, p = 0.002) and inversely with fractional shortening (rs = -.66, p = 0.014). In children with cold shock, brain natriuretic peptide at 12 hrs (718 pg/mL) [63-1530] was higher (p = 0.007) than in those with warm shock (208 pg/mL [20-366]). There was no pattern (p > 0.05) observed for brain natriuretic peptide over time.. Brain natriuretic peptide measured early after admission is increased in children with septic shock, especially in those with cold shock. In addition, the level at 12 hrs correlates with both severity of illness and myocardial dysfunction. Brain natriuretic peptide may be useful in assessing myocardial dysfunction from septic shock, particularly in identifying children with cold shock. Further studies are warranted to determine whether this measurement will be helpful in guiding therapy in pediatric septic shock.

Topics: Adolescent; California; Case-Control Studies; Child; Child, Preschool; Echocardiography; Female; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain; Observation; Prospective Studies; Shock, Septic; United States

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

Topics: Biomarkers; Humans; Intensive Care Units; Natriuretic Peptide, Brain; Shock, Septic

Topics: Biomarkers; Heart Failure; Humans; Natriuretic Peptide, Brain; Pediatric Nursing; Shock, Septic

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

B-type natriuretic peptide (BNP) and its N-terminal portion (NT-pro-BNP) are used for the assessment of cardiac dysfunction in patients with heart failure. However, it remains controversial whether or not this option is still valid in critically ill patients because of a possible interaction between the systemic inflammatory response and the natriuretic peptide levels. The aim of this study was to assess the relationship between natriuretic peptic levels, laboratory parameters of systemic inflammation, and pulmonary artery occlusion pressure (PAOP) in critically patients.. Twelve haemodyamic unstable patients, all monitored with a pulmonary artery catheter, were included in this study. Subgroups were compared using measurement values on ICU admission. Within patient associations between different variables were evaluated by a repeated measurement ancova.. Acute heart failure and septic shock were diagnosed in 6 patients each. Despite significant differences in cardiac index and troponin T plasma level, BNP and NT-pro-BNP levels did not differ significantly between the two groups. Within patient, changes in BNP and NT-pro-BNP levels correlated significantly (p<0.01) with those in C-reactive protein values and those in leukocyte counts, but did not follow changes in PAOP.. Our results add further evidence to the hypothesis that there is an interaction between the systemic inflammatory response and the natriuretic peptides. Thus, BNP and NT-pro-BNP levels should only be used cautiously as surrogates of cardiac filling and function in haemodynamic unstable critically ill patients.

Topics: Aged; Biomarkers; C-Reactive Protein; Critical Illness; Female; Heart Failure; Humans; Leukocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Shock, Septic

To evaluate the NT-proBNP as a biological diagnosis marker of the myocardial dysfunction in septic shock.. Non-randomized prospective clinical study with written assent. The analysis of the data obtained was retrospective.. All the patients with septic shock in the beginning of evolution (less than 24h) were included. Patients with cardiac insufficiency, insufficient respiratory function and chronic renal insufficiency as well as cirrhotic patients were excluded. Among patients in shock, a NT-proBNP concentration measurement and a cardiac echography by transthoracic way were carried out at inclusion. The rates of NT-proBNP were compared with the data of the echography.. Thirty-three patients in septic shock were included. On the whole of the collective, whether or not there is a cardiac dysfunction, the rates of NT-proBNP are not significantly different (11,306+/-16,196 pg/ml versus 10,697+/-12,346 pg/ml). By eliminating the patients with severe renal failure, we show that the NT-proBNP is non-significantly increased in the event of right and/or left ventricular failure (5751+/-4180 pg/ml versus 1,256+/-999 pg/ml).. The NT-proBNP can help to detect the cardiogenic share sometimes implied in the haemodynamic failure of the septic shock. However, because of the influence of the renal insufficiency and the respiratory, cardiologic and hepatic comorbidities on its secretion, its use cannot be recommended for patients in septic shock.

Topics: Aged; Biomarkers; Female; Humans; Kidney; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Shock, Septic; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right

The biomarkers lactate, procalcitonin, and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are often promoted as being useful for prognostication in septic shock. This study aimed to compare the prognostic utility of these biomarkers with each other and with cytokine measurements and clinical severity scores, and to assess how these biomarkers may be combined to improve their prognostic utility. Seventy-two patients with septic shock were studied. The biomarkers were measured on the first 3 days of stay in the intensive care unit together with serum IL-1beta, IL-6, IL-10, and TNF-alpha levels. Although elevated baseline lactate levels predicted 28-day mortality, elevated procalcitonin and NT-proBNP levels were only predictive from days 2 and 3, respectively. The prognostic utility of baseline lactate levels was poorer than that of baseline cytokine levels, the Acute Physiology and Chronic Health Evaluation II score, and the Sequential Organ Failure Assessment score. However, a rising trend in lactate and procalcitonin levels between days 1 and 2 had superior prognostic utility compared with absolute levels. Indeed, using multivariate analysis, the presence of a concurrent increase in both lactate and procalcitonin levels between days 1 and 2 superseded all cytokine measurements and clinical severity scores as the sole independent predictor of 28-day mortality. In conclusion, elevated baseline lactate levels offer superior prognostic accuracy to baseline procalcitonin levels, which in turn are superior to NT-proBNP levels. To improve their prognostic utility beyond those of cytokine measurements and clinical severity scores, serial lactate and procalcitonin measurements may be combined.

Topics: Adult; Aged; Analysis of Variance; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Female; Humans; Lactic Acid; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein Precursors; Severity of Illness Index; Shock, Septic

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

Septic shock (SS) has recently been identified as stimulus of N-terminal pro-brain natriuretic peptide (NT-proBNP) release. We tested whether SS mediates NT-proBNP release through cardiomyocyte necrosis. Moreover, the discriminative value of NT-proBNP for the distinction between SS and non-septic shock (NSS) was assessed.. The study included 50 ICU patients with SS (n=25) and NSS (n=25), 40 patients with acute coronary syndrome and elevated troponin-I (ACStrop+) and 16 patients with unstable angina and normal troponin-I (UAtrop-). Eleven subjects without inflammation or cardiac disease served as controls. NT-proBNP levels of coronary patients were measured on admission, those of ICU patients 48 h after onset of shock symptoms.. ACStrop+ (1525 [25th-75th percentile: 790-3820] pg/L) and NSS (687 [254-1552]) patients showed increased NT-proBNP levels above those of UAtrop- patients (107 [43-450], p<0.001) and controls (52 [42-99], p<0.001), but SS patients exhibited still higher levels (11,335 [4716-25,769], p<0.001 vs all others). Among ICU patients with shock symptoms, NT-proBNP discriminated SS and NSS with high sensitivity and specificity (area under ROC curve: 0.946 [95% confidence interval, 0.872-1.019]). NT-proBNP correlated with troponin-I, as marker of cardiomyocyte damage, among ACStrop+ (p<0.001) and SS patients (p=0.013). But, whereas SS patients showed the greatest NT-proBNP values, ACStrop+ patients had higher troponin-I levels (p<0.001), suggesting different mechanisms by which myocardial ischemia and SS mediate NT-proBNP release.. SS is a more potent stimulus of NT-proBNP release than myocardial ischemia. NT-proBNP reliably distinguishes SS from other forms of shock. SS-related NT-proBNP release appears to involve cardiomyocyte damage but not genuine cardiomyocyte necrosis.

Topics: Aged; Angina, Unstable; APACHE; Comorbidity; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Myocytes, Cardiac; Natriuretic Peptide, Brain; Necrosis; Peptide Fragments; Prognosis; Shock, Septic; Syndrome

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

The overall prognosis of critically ill patients with cancer has improved during the past decade. The aim of this study was to identify early prognostic factors of intensive care unit (ICU) mortality in patients with cancer.. We designed a prospective, consecutive, observational study over a one-year period. Fifty-one cancer patients with septic shock were enrolled.. The ICU mortality rate was 51% (26 deaths). Among the 45 patients who benefited from transthoracic echocardiography evaluation, 17 showed right ventricular dysfunction, 18 showed left ventricular diastolic dysfunction, 18 showed left ventricular systolic dysfunction, and 11 did not show any cardiac dysfunction. During the first three days of ICU course, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in patients presenting cardiac dysfunctions compared to patients without any cardiac dysfunction. Multivariate analysis discriminated early prognostic factors (within the first 24 hours after the septic shock diagnosis). ICU mortality was independently associated with NT-proBNP levels at day 2 (odds ratio, 1.2; 95% confidence interval, 1.004 to 1.32; p = 0.022). An NT-proBNP level of more than 6,624 pg/ml predicted ICU mortality with a sensitivity of 86%, a specificity of 77%, a positive predictive value of 79%, a negative predictive value of 85%, and an accuracy of 81%.. We observed that critically ill cancer patients with septic shock have an approximately 50% chance of survival to ICU discharge. NT-proBNP was independently associated with ICU mortality within the first 24 hours. NT-proBNP could be a useful tool for detecting high-risk cancer patients within the first 24 hours after septic shock diagnosis.

Topics: Aged; Echocardiography; Echocardiography, Doppler; Female; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Neoplasms; Prognosis; Prospective Studies; ROC Curve; Shock, Septic; Troponin I

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

B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP) plasma levels are commonly high at the early phase of septic shock and have been suggested to be prognostic markers for this condition. It is uncertain, however, whether this increase reflects sepsis related cardiac dysfunction. In a recent issue of Critical Care, Mokart and coworkers showed the accuracy of NT-proBNP in predicting intensive care unit mortality in cancer patients with septic shock, which could help in identifying high risk cancer patients. Results from repeated transthoracic echocardiographs show that NT-proBNP on day 2 after admission was higher in patients presenting with cardiac dysfunction, whereas NT-proBNP on day 1 did not predict cardiac dysfunction. These data suggest that after an initial overexpression of NT-proBNP in all septic patients, patients with cardiac dysfunction will present persistent high levels of NT-proBNP.

Topics: Aged; Biomarkers; Environmental Monitoring; Hospital Mortality; Humans; Intensive Care Units; Natriuretic Peptide, Brain; Neoplasms; Peptide Fragments; Prognosis; Research Design; Shock, Cardiogenic; Shock, Septic

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

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

Our objective was to investigate the plasma levels of brain and atrial natriuretic peptides (BNP and ANP, respectively) in patients with septic shock/severe sepsis and to study the association of BNP and ANP levels with hemodynamic parameters, severity of the disease, and prognosis of those patients. This is a prospective case series study of 22 patients with septic shock, 11 patients with severe sepsis, and 20 healthy volunteers at the Department of Emergency and Critical Care Medicine, Nara Medical University Hospital, Japan. Blood collection was performed on admission and on days 1, 2, and 4. Plasma BNP and ANP levels were measured by radioimmunoassay. Right atrial pressure, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, and left ventricular stroke work index were determined using a thermodilution catheter. Acute Physiological and Chronic Health Evaluation II scores were calculated. Plasma levels of BNP and ANP were markedly elevated in patients with septic shock/severe sepsis compared with controls (BNP, 7 +/- 0.3 pg mL; ANP, 13 +/- 1 pg mL). In patients with septic shock, both BNP and ANP peaked on day 2 (BNP, 987 +/- 160 pg mL; ANP, 103 +/- 17 pg mL). Plasma levels of BNP on day 2 in patients with septic shock significantly correlated with right atrial pressure (r = 0.744, P < 0.01), mean pulmonary arterial pressure (r = 0.670, P < 0.01), pulmonary arterial wedge pressure (r = 0.709, P < 0.01), left ventricular stroke work index (r = -0.552, P < 0.05), Acute Physiological and Chronic Health Evaluation II score (r = 0.581, P < 0.01), and poor prognosis (P < 0.05). The optimal cutoff point for predicting mortality in patients with septic shock was a BNP level of 650 pg mL on day 2, in which sensitivity and specificity were 92% and 80%, respectively. Increased plasma levels of BNP may reflect not only the severity of myocardial depression but also the disease severity and could be of prognostic value in patients with septic shock.

Topics: Adult; Aged; Atrial Natriuretic Factor; Female; Fluid Therapy; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Reference Values; Respiratory Distress Syndrome; Severity of Illness Index; Shock, Septic

Topics: Heart Diseases; Humans; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Predictive Value of Tests; ROC Curve; Shock, Septic

Nesiritide is a recombinant formulation of B-type natriuretic peptide used most commonly in the treatment of adults with decompensated congestive heart failure. The physiologic effects of BNP include natriuresis, diuresis, and smooth muscle relaxation. These physiologic effects result in its beneficial therapeutic effects, including a decrease in afterload, resulting in increased cardiac output with improved peripheral perfusion. The authors report on a 17-year-old with acute myelogenous leukemia who was admitted to the Pediatric ICU for treatment of septic shock, respiratory failure, myocardial dysfunction, and renal insufficiency. After the initial stabilization of his hemodynamic status, nesiritide was started and resulted in a stable balance of fluid intake versus output without the use of diuretics, improvement in myocardial function, and recovery of renal function manifested by a decrease of blood urea nitrogen and creatinine back to baseline values. The end-organ effects of nesiritide, previous reports regarding its use in the pediatric population, and its potential applications in the ICU setting are discussed.

Topics: Adolescent; Cardiomyopathies; Humans; Leukemia, Myeloid, Acute; Natriuretic Peptide, Brain; Renal Insufficiency; Respiratory Insufficiency; Shock, Septic; Treatment Outcome; Water-Electrolyte Balance

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

N-terminal pro brain natriuretic peptide (NT-proBNP) is a cardiac biomarker that has recently shown to be of diagnostic value in a diagnosis of decompensated heart failure, acute coronary syndromes and other conditions resulting in myocardial stretch. We sought to study whether sepsis-induced myocardial dilation would result in an elevation of NT-proBNP.. Serum NT-proBNP measurements were made in six consecutive patients with septic shock within 6 hours of admission to the intensive care unit.. Markedly elevated levels of NT-proBNP were found in all six patients.. NT-proBNP levels can be markedly elevated in critically ill patients presenting with septic shock. An elevated NT-proBNP level in a critically ill patient is not specific for decompensated heart failure.

Topics: Adult; Aged; Biomarkers; Cardiomyopathies; Female; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; ROC Curve; Shock, Septic

Interest has recently focused on the use of neurohormonal markers such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) as indices of left ventricular systolic dysfunction and prognosis in heart failure. Also, peptides belonging to the interleukin-6 (IL-6) family have been shown to induce ANP and BNP secretion. We hypothesized that BNP and ANP spillover in the peripheral circulation reflects left ventricular dysfunction and IL-6 production in septic shock.. Retrospective, clinical study in the medical intensive care unit of a university hospital.. 17 patients with septic shock and 19 control subjects.. Collection of clinical and demographic data in relation to ANP, BNP, IL-6, and soluble TNF receptors (sTNF-R-p55, sTNF-R-p75) in plasma over a period of 4 days.. In septic shock we found a significant increase in ANP (82.7+/-9.9 vs. 14.9+/-1.2 pg/ml) and BNP (12.4+/-3.6 vs. 5.5+/-0.7 pg/ml). Plasma ANP peaked together with IL-6. Peaks of ANP and IL-6 were significantly correlated (r=0.73; p<0.01). BNP was inversely correlated to cardiac index (r=-0.56; p<0.05).. ANP and BNP increase significantly in patients with septic shock. BNP reflects left ventricular dysfunction. ANP is related to IL-6 production rather than to cardiovascular dysfunction.

Topics: Atrial Natriuretic Factor; Female; Follow-Up Studies; Humans; Interleukin-6; Male; Middle Aged; Natriuretic Peptide, Brain; Retrospective Studies; Shock, Septic; Time Factors; Ventricular Dysfunction, Left

Topics: Diagnostic Errors; Dyspnea; Emergency Treatment; Escherichia coli Infections; Heart Failure; Humans; Muscle Weakness; Natriuretic Peptide, Brain; Pseudomonas Infections; Shock, Septic

We have previously reported that C-type natriuretic peptide (CNP), the third member of natriuretic family, was produced in vascular endothelial cells and hypothesized that CNP might be a local regulator of vascular tone and/or growth from endothelial cells. In order to clarify the pathophysiological significance of CNP in humans, we examined the presence of CNP in human circulation and determined plasma levels of CNP in patients with various cardiovascular disorders. The plasma level of CNP in healthy persons was 1.4 +/- 0.6 fmol/ml (n = 13). The plasma level of CNP was markedly increased in patients with septic shock (13.2 +/- 10.1 fmol/ml, n = 11), while there was no alteration in patients with congestive heart failure or hypertension. There was two-fold increase of the plasma CNP level in patients with chronic renal failure. These results indicate that CNP, which can be considered as an endothelium-derived relaxing peptide, is detectable in human circulation and suggest the pathophysiological significance of endothelial CNP in humans.

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Chromatography, Gel; Chromatography, High Pressure Liquid; Cross Reactions; Heart Failure; Humans; Hypertension; Kidney Failure, Chronic; Middle Aged; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Nerve Tissue Proteins; Reference Values; Shock, Septic