Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis
Brain natriuretic peptide: A marker of myocardial dysfunction and prognosis during severe sepsis
复制标题
DOI：
10.1097/01.ccm.0000114827.93410.d8
复制
发表时间：
2004-03-01
影响因子：
8.8
通讯作者：
Chiche, JD
中科院分区：
文献类型：
--
作者：
Charpentier, J;Luyt, CE;Chiche, JD
目的：探讨血浆脑钠肽水平作为严重脓毒症和脓毒性休克时收缩期心肌功能障碍的标志物的价值。重症监护室，病人：共有34例连续严重脓毒症（9例）或脓毒性休克（25例）的患者没有以前的心脏，呼吸，或慢性renal failure.Interventions：无测量和主要结果：心肌收缩性能进行了评估，通过分数面积收缩（FAC）使用超声心动图进行第2天（FAC（D2））和8。在严重脓毒症开始后第1-4天和第8天测量血浆脑钠肽水平。在34例患者中（简化急性生理学评分II，43 +/- 2.5），15例（44%）出现初始心肌功能障碍（FAC（D2）< 50%）。肺是65%患者败血症的起源。28天死亡率为29%。在具有（FACD 2 < 50%）和不具有（FAC（D2）大于或等于50%）心肌功能障碍的患者之间进行比较。从第2天到第4天，FAC（D2）< 50%的患者的血浆脑钠肽水平显著高于FAC（D2）大于或等于2：50%的患者（p <0.05）。在重症监护病房期间死亡的患者在第2天和第3天的脑钠肽水平也显著较高（p <0.05）。44%的严重脓毒症或脓毒性休克患者存在收缩性心肌功能障碍。在这种情况下，脑钠肽似乎有助于检测心肌功能障碍，高血浆水平似乎与脓毒症的不良结局相关，但需要进一步研究。
Objective: To investigate the value of brain natriuretic peptide plasma levels as a marker of systolic myocardial dysfunction during severe sepsis and septic shock.Design: Prospective observational study.Setting. Intensive care unit.Patients: A total of 34 consecutive patients with severe sepsis (nine patients) or septic shock (25 patients) without previous cardiac, respiratory, or chronic renal failure.Interventions: None.Measurements and Main Results: Myocardial systolic performance was assessed by fractional area contraction (FAC) using echocardiography performed on days 2 (FAC(D2)) 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 (FAC(D2) < 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 (FAC(D2) greater than or equal to 50%) myocardial dysfunction. Plasma levels of brain natriuretic peptide were significantly higher in patients with FAC(D2) < 50% than in those with FAC(D2) greater than or equal to 2: 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).Conclusions. 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.