natriuretic-peptide--c-type and Sepsis

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Humans; Intensive Care Units; Natriuretic Peptide, C-Type; Prognosis; Protein Precursors; Sepsis

Topics: Adolescent; Adult; Biomarkers; Critical Care; Humans; Lithostathine; Natriuretic Peptide, C-Type; Pilot Projects; Respiration, Artificial; Sepsis; Wounds and Injuries

Topics: Critical Care; Humans; Lithostathine; Natriuretic Peptide, C-Type; Sepsis; Wounds and Injuries

C-type natriuretic peptide (CNP) is a paracrine molecule which is mainly synthesized in the vasculature. High levels have been reported in sepsis, and CNP has been proposed as a biomarker predicting sepsis in traumatized patients. We aimed at evaluating the diagnostic and prognostic value of N-terminal pro-CNP (NT-proCNP) for predicting sepsis, disease severity and mortality in critically ill medical patients.. 273 critically ill patients (197 patients with sepsis or septic shock, 76 without evidence of sepsis) and 43 healthy controls were consecutively included in a prospective clinical single-center non-interventional study at the Medical Intensive Care Unit, RWTH-University Aachen, Germany. Patients' outcome was followed for about 1 year. NT-proCNP serum concentrations were determined upon ICU admission, as well as in the mornings of day 3 and day 7 after admission. Intensive care treatment measures as well as routine and experimental laboratory parameters were recorded and analyzed.. NT-proCNP serum concentrations upon admission to the ICU were elevated in critically ill patients as compared with healthy controls. Patients with sepsis had significantly higher NT-proCNP levels than non-sepsis patients. NT-proCNP was strongly associated with inflammatory parameters (i.e. C-reactive protein, procalcitonin and TNF-α), biomarkers of organ dysfunction and clinical composite scores (APACHE-II, SOFA, SAPS2). NT-proCNP levels at admission and day 3 were found to be a strong predictive marker for ICU- and overall survival. Moreover, a decline of serum NT-proCNP after admission to the ICU was associated with reduced mortality. The predictive power of serum NT-proCNP was similar to 'conventional' prognostic tools such as clinical scores.. NT-proCNP is significantly elevated in critically ill patients, with highest levels in sepsis. Inflammation as well as organ function are strongly associated with NT-proCNP serum concentrations. Low initial NT-proCNP levels and a decline during initial treatment indicate a favourable ICU- and long-term outcome.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Case-Control Studies; Critical Illness; Female; Follow-Up Studies; Germany; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, C-Type; Predictive Value of Tests; Prognosis; Prospective Studies; Sepsis; Severity of Illness Index; Treatment Outcome; Young Adult

C-type natriuretic peptide (CNP), a member of the natriuretic peptide family, is produced in vascular endothelium. We assessed the accuracy of natriuretic (NT)-proCNP, the N-terminal fragment of the C-type natriuretic peptide precursor, in predicting development of sepsis in multiple-traumatized patients with/without traumatic brain injury verified by computed tomography.. Retrospective clinical study.. Level II trauma center.. Three patient groups were stratified according to computed tomography results: isolated traumatic brain injury (n = 20), multiple-traumatized with traumatic brain injury (n = 26) and multiple-traumatized without traumatic brain injury (n = 26). During 13 days after multiple trauma, 37 (51%) patients developed sepsis.. Circulating plasma NT-proCNP levels were measured daily (days 0-13) in all patients. Without any retrospective stratification of trauma patients, plasma NT-proNCP levels did not differ in septic (n = 37) and nonseptic (n = 35) patients (p = .505). Between days 2 and 6 posttrauma, there was a significant (p = .002) increase of circulating NT-proCNP in multiple-traumatized patients without traumatic brain injury who developed sepsis (n = 19) compared with nonseptic multiple-traumatized patients without traumatic brain injury. Conversely, in septic patients either with traumatic brain injury alone or with multiple trauma and traumatic brain injury, the NT-proCNP showed a trend toward lower levels than in nonseptic patients. Prediction of sepsis (receiver-operating characteristic test) from days 2 to 6 after multiple trauma by NT-proCNP in patients without traumatic brain injury was accurate with an area under the curve of 0.84 +/- 0.03. The optimal cutoff value of 2.3 pmol/L produced sensitivity of 84% to 96% and specificity of 61% to 91% from day 2 to 6 after trauma.. Our data showed that the levels of circulating NT-proCNP between multiple-traumatized patients without traumatic brain injury who do and do not develop sepsis are distinctly different. Plasma NT-proCNP concentration can potentially serve as an accurate predictor of sepsis in this cohort of patients.

Topics: Adult; Analysis of Variance; APACHE; Austria; Biomarkers; Brain Injuries; Cohort Studies; Critical Care; Female; Follow-Up Studies; Glasgow Coma Scale; Hospital Mortality; Humans; Injury Severity Score; Male; Middle Aged; Multiple Trauma; Natriuretic Peptide, C-Type; Normal Distribution; Predictive Value of Tests; Probability; Retrospective Studies; Risk Assessment; Sepsis; Survival Rate; Trauma Centers; Young Adult

Topics: Biomarkers; Brain Injuries; Critical Care; Critical Illness; Female; Humans; Intensive Care Units; Male; Multiple Trauma; Natriuretic Peptide, C-Type; Predictive Value of Tests; Prognosis; Risk Assessment; Sepsis; Survival Analysis