The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock
The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock
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DOI：
10.5935/0103-507x.20190060
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发表时间：
2019-09-01
影响因子：
--
通讯作者：
Vallabhajosyula, Saraschandra
中科院分区：
文献类型：
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作者：
Pandompatam, Govind;Kashani, Kianoush;Vallabhajosyula, Saraschandra
败血症仍然是美国和世界范围内的主要公共卫生负担。随着先进实验室技术的使用越来越多，人们对在脓毒症中使用生物标记物以帮助更准确和有针对性的决策重新产生了兴趣。利钠肽在心力衰竭之外的作用已被越来越多地认识到。在心肺功能不全的危重患者中，它们通常升高，并可能在鉴别败血症和感染性休克患者中发挥作用。关于这些生物标志物在脓毒症患者的诊断、治疗、结果和预后中的作用的数据有限。本文综述了利钠肽在液体复苏、心功能不全的诊断和脓毒症患者预后中的作用。B型利钠肽(BNP)和N末端前体BNP(NT-proBNP)与感染性心肌病患者的左、右室收缩、舒张期和右室功能障碍有关。BNP/NT-proBNP可预测液体反应性，这些多肽的变化趋势可能在液体复苏中发挥作用。尽管提示BNP与死亡率相关，但BNP在脓毒症期间的死亡率结果和预后中的作用仍需进一步评估。
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.