Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis
Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis
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DOI：
10.1161/circulationaha.104.472050
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发表时间：
2005-07-26
期刊：
影响因子：
37.8
通讯作者：
Hoffmann, U
中科院分区：
文献类型：
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作者：
Brueckmann, M;Huhle, G;Hoffmann, U
背景 - 心房钠尿肽 (ANP) 和脑钠尿肽 (BNP) 血浆水平升高已被确定为心功能不全以及充血性心力衰竭和缺血性心脏病预后的预测因子。然而，在严重脓毒症患者中，尚无关于利尿钠肽的预后价值的信息。因此，本研究的目的是确定 ANP (NT-proANP) 和 BNP (NT-proBNP) N 端激素原形式在脓毒症患者预后中的作用。此外，还评估了重组人活化蛋白 C [drotrecogin alfa（活化）] 治疗对严重脓毒症血浆利尿钠肽水平的影响。方法和结果 - 纳入了 57 名严重脓毒症患者。在脓毒症第二天通过 ELISA 测量 NT-proANP 和 NT-proBNP 的水平。 NT-proBNP 水平 > 1400 pmol/L 的脓毒症患者死于脓毒症的可能性是 NT-proBNP 值较低的患者的 3.9 倍（相对风险 [RR]，3.9；95% CI，1.6 至 9.7）（P < 0.01）。然而，NT-proANP 水平并不能预测我们患者群体的生存情况。脓毒症患者肌钙蛋白 I 水平与血浆 NT-proBNP 浓度之间存在高度显着相关性（r=0.68，P < 0.0001）。此外，肌钙蛋白 I 显着解释了 NT-proBNP 水平的变化（P < 0.0001），表明 NT-proBNP 在脓毒症患者心脏损伤和功能障碍中发挥着重要作用。与未接受 drotrecogin alfa（激活）治疗的 23 名脓毒症患者相比，接受 drotrecogin alfa（激活）治疗的 23 名脓毒症患者的 NT-proANP、NT-proBNP 和肌钙蛋白 I 浓度显着降低。结论 - NT-proBNP 可作为有用的实验室标志物来预测严重脓毒症患者的生存情况。
Background - Increased plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) have been identified as predictors of cardiac dysfunction and prognosis in congestive heart failure and ischemic heart disease. In severe sepsis patients, however, no information is available yet about the prognostic value of natriuretic peptides. Therefore, the aim of the present study was to determine the role of the N-terminal prohormone forms of ANP (NT-proANP) and BNP (NT-proBNP) in the context of outcome of septic patients. Furthermore, the effect of treatment with recombinant human activated protein C [drotrecogin alfa (activated)] on plasma levels of natriuretic peptides in severe sepsis was evaluated.Methods and Results - Fifty-seven patients with severe sepsis were included. Levels of NT-proANP and NT-proBNP were measured on the second day of sepsis by ELISA. Septic patients with NT-proBNP levels > 1400 pmol/L were 3.9 times more likely (relative risk [RR], 3.9; 95% CI, 1.6 to 9.7) to die from sepsis than patients with lower NT-proBNP values (P < 0.01). NT-proANP levels, however, were not predictive of survival in our patient population. A highly significant correlation was found between troponin I levels and plasma concentrations of NT-proBNP in septic patients (r=0.68, P < 0.0001). In addition, troponin I significantly accounted for the variation in NT-proBNP levels (P < 0.0001), suggesting an important role for NT-proBNP in the context of cardiac injury and dysfunction in septic patients. Twenty-three septic patients who received treatment with drotrecogin alfa (activated) presented with significantly lower concentrations of NT-proANP, NT-proBNP, and troponin I compared with patients not receiving drotrecogin alfa (activated).Conclusions - NT-proBNP may serve as useful laboratory marker to predict survival in patients presenting with severe sepsis.