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Prognostic value of circulating amino-terminal pro-C-type natriuretic peptide in critically ill patients
Alexander Koch, Sebastian Voigt, Edouard Sanson, Hanna Dückers, Andreas Horn, Henning W Zimmermann, Christian Trautwein, Frank Tacke
Critical Care , 2011, DOI: 10.1186/cc10007
Abstract: 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.The natriuretic peptide family consists of three distinctive members: atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and C-type natriuretic peptide (CNP). These peptides exert multiple potent diuretic, natriuretic and vasorelaxant functions, thereby directly influencing body-fluid homeostasis and blood pressure control [1,2].
Brain natriuretic peptide: Diagnostic potential in dogs  [PDF]
Spasojevi?-Kosi? Ljubica
Veterinarski Glasnik , 2009, DOI: 10.2298/vetgl0906381k
Abstract: The endocrine role of the heart is evident in the secretion of noradrenaline and natriuretic peptides. The secretion of natriuretic peptides presents a useful mechanism for different conditions of cardiac dysfunction. Brain natriuretic peptide (BNP) has been accepted in human cardiology as a biomarker for cardiac insufficiency and coronary arterial disease. The specificity of the BNP structure is specie-specific, so that the testing of diagnostic and prognostic potential in dogs requires the existence of a test that is a homologue for that animal specie. The existence of an adequate method for measuring BNP concentration makes possible its implementation as a screening test in everyday clinical practice. .
CLINICAL USE OF NATRIURETIC PEPTIDES. A REVIEW  [cached]
Mugdim Bajric,Fahir Barakovic,Nusret Sinanovic,Denis Mrsic
Acta Medica Saliniana , 2008, DOI: 10.5457/ams.19.08
Abstract: The most significant discoveries in the area of heart failure are the recognition of natriuretic peptide system and its multiple effects on cardiac structure and function with special effect on its natriuretic and hemodynamic processes. First information’s that heart, beside its function as a mechanical pump also has an important endocrine functions, exists for over 50 years. Chemical structure of atrial natriuretic peptide has been identified in 1984. and four years later a brain natriuretic peptide has been discovered owning its name because it has been identified in pig brain. Primary site of brain natriuretic peptide synthesis in heart has been identified in 1991. Natriuretic peptides are neither neurohormones that influence body fluid homeostasis through natriuretic and diuretic effect; regulate vascular tone by decreasing angiotensine II level and they inhibit nor epinephrine synthesis and increase parasympathetic tone. They are natural antagonists of renin-angiotensine-aldosteron system, and they have a great role in inhibition of ventricular hypertrophy and remodeling, protective effects in endothelial dysfunction are important; they increase effects of nitrite oxide, inhibit lipid deposition in vascular wall and inhibit thrombocyte activation, regulate coagulation and fibrinolytic processes as well. Natriuretic peptides clinical use is in early evaluation of heart failure, prognostic stratification and detection of systolic and diastolic dysfunction of left ventricle, assessment of prognosis during patient monitoring period, differential diagnosis of dyspnea, treatment adjustment and dosage titration, assessment during hospital admittance and discharge and forecast and reduction of coronary events.
N-terminal pro-brain natriuretic peptide as an early prognostic factor in cancer patients developing septic shock
Djamel Mokart, Antoine Sannini, Jean-Paul Brun, Marion Faucher, Didier Blaise, Jean-Louis Blache, Catherine Faucher
Critical Care , 2007, DOI: 10.1186/cc5721
Abstract: 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.The overall prognosis of critically ill patients with cancer has improved during the past decade [1,2]. Reports concerning critically ill patients with malignancies admitted to the intensive care unit (ICU) include a wide range of causes, including septic shock. In this population, mortality rates tend to be approximately 50% when septic shock is present [2,3]. Despite the presence of life-threatening factors such as neutropenia or bone marrow transplantation, prognostic factors in the develo
Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism  [PDF]
Abdelhakem Selem, Hanan Radwan, Abdelaziz M Gomaa
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2012, DOI: 10.4236/ojemd.2012.24009
Abstract: Patients with pulmonary embolism (PE) have a high risk of death and it is important to recognize factors associated with high mortality. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has recently emerged as a promising biomarker for risk assessment in acute pulmonary embolism (PE). The aim of this study is to detect the in hospital prognostic value of NT-pro BNP in patients with acute (PE). Methods: This study included 64 patients diagnosed as (PE) with the mean age of 59.1 ± 16.5 years, 40 patients of them (62.5%) were male. All patients were subjected to 12 leads ECG. X-ray chest, laboratory tests including D-Dimer, troponin I, NT-pro BNP, Doppler ultrasound for the venous system of both lower limbs, Echocardiograhy and 64 multislices CT pulmonary angiography. Results: According to the admission level of NT-pro BNP our patients were divided into two groups: group I included 22 patients with normal NT-pro BNP (less than 300 pg/ml), and group II included 42 patients with elevated NT-pro BNP (more than or equal 300 pg/ml). Patients in group II were found to have a significantly higher incidence of heart failure (28.6% Vs 4.6%, p = 0.025), impaired kidney function (serum creatinine was 1.7 ± 0.6 Vs 1.1 ± 0.2, p = 0.018), tachypnea (85.7% Vs 54.5%, p = 0.006) and cardiogenic shock (26.2% Vs 0%, p = 0.014) but a significantly lower incidence of chest pain (21.4% Vs 45.5%, p = 0.04) and lower left ventricular ejection fraction (51.3% ± 16.9% Vs 67.3% ± 12.8%, p = 0.043) compared to group I. There were a significantly higher treatment with thrombolytic therapy (35.7% Vs 9.1%, p=0.021) and positive inotropics (35.71% Vs 4.55%, p = 0.006) in group II compared to group I. Also group II had a higher need for mechanical ventilation (26.12% Vs 4.55%, p = 0.04) and a longer in hospital stay (19.5 ± 10.3 Vs 5.3 ± 4.5, p = 0.001) than group I. The in hospital mortality was significantly higher in group II compared to group I (19.05% Vs 0.0%, p = 0.042). Conclusion: Elevated NT-pro BNP levels in patients with (PE) are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.
血浆脑钠肽水平对急性脑出血患者转归的预测价值
Prognostic Value of Plasma Brain Natriuretic Peptide Levels in Patients with Acute Intracerebral Hemorrhage
 [PDF]

韦道明, 朱雪红, 高丽丽, 杨瑞玲, 林菊珊, 廖远生, 李世举, 吴成翰
International Journal of Psychiatry and Neurology (IJPN) , 2015, DOI: 10.12677/IJPN.2015.44005
Abstract:
目的:探讨血浆脑钠肽(BNP)水平与脑出血患者预后的关系。方法:回顾性分析2010年12月~2013年12月治疗的109例脑出血患者,根据转归分为转归良好组和转归不良组。采用酶联免疫吸附法(ELISA)测定血浆BNP。结果:患者卒中病史、吸烟史、血肿体积、格拉斯哥昏迷评分、美国国立卫生研究量卒中量表评分、血肿是否破入脑室及血浆脑钠肽水平均与转归结果有密切关系(X2 = 3.678, 7.096, t = 2.962, 2.361, 3.806, X2 = 4.687, t = 4.962, P < 0.05); Logistic回归分析发现血浆脑钠肽水平与急性脑出血患者的预后相关(P = 0.032, OR = 1.789, 95% CI 1.052~3.043)。结论:血浆BNP是脑出血患者转归的危险因素之一,对患者预后的判断有一定的价值。
Objective: To study brain natriuretic peptide (BNP) levels and prognosis in patients with cerebral hemorrhage. Methods: Retrospective analysis of 109 cases with cerebral hemorrhage from December 2010 to December 2014 for the treatment was divided into 2 groups, according to the outcome of a good outcome group and poor outcome groups. The enzyme-linked immunosorbent assay (ELISA) was used for determination of plasma BNP. Result: There was a close relationship between patient outcomes and a previous history of stroke, smoking history, hematoma volume, Glasgow Coma Scale score, National Research Health Stroke Scale score, rupture of hematoma into the ventricle, plasma brain natriuretic peptide level. (X2 = 3.678, 7.096, t = 2.962, 2.361, 3.806, X2 = 4.687, t = 4.962, P < 0.05); Logistic regression analysis revealed a correlation between the prognosis of brain natriuretic peptide levels in patients with acute cerebral hemorrhage (P = 0.032, OR = 1.789, 95% CI 1.052 - 3.043). Conclusions: Plasma brain natriuretic peptide level is an independent risk factor for patients with cerebral hemorrhage and may be a useful prognostic factor for these patients.
N-Terminal Pro-Brain Natriuretic Peptide Is a Useful Prognostic Marker in Patients with Pre-Capillary Pulmonary Hypertension and Renal Insufficiency  [PDF]
Lars Harbaum, Jan K. Hennigs, Hans J. Baumann, Nicole Lüneburg, Elisabeth Griesch, Carsten Bokemeyer, Ekkehard Grünig, Hans Klose
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0094263
Abstract: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a routinely used prognostic parameter in patients with pre-capillary pulmonary hypertension (PH). As it accumulates in the presence of impaired renal function, the clinical utility of NT-proBNP in PH patients with concomitant renal insufficiency remains unclear. In a retrospective approach, patients with pre-capillary PH (group I or IV) and concomitant renal insufficiency at time of right heart catheterization (glomerular filtration rate (GFR) ≤60 ml/min/1.73 m2) were identified out of all prevalent pre-capillary PH patients treated at a single center. Forty patients with renal insufficiency (25.8%) were identified and matched regarding hemodynamic parameters with a control group of 56 PH patients with normal renal function (GFR >60 ml/min/1.73 m2). Correlations of NT-proBNP levels with hemodynamic and prognostic parameters (time to clinical worsening and overall survival) were assessed. Overall, GFR correlated inversely with NT-proBNP and had the strongest influence on NT-proBNP levels in a stepwise multiple linear regression model including hemodynamic parameters and age (r2 = 0.167). PH patients with renal insufficiency had significant higher levels of NT-proBNP (median: 1935 ng/l vs. 573 ng/l, p = 0.001). Nevertheless, NT-proBNP correlated with invasive hemodynamic parameters in these patients. Using higher cut-off values than in patients with preserved renal function, NT-proBNP levels were significantly associated with time to clinical worsening (>1660 ng/l, p = 0.001) and survival (>2212 ng/l, p = 0.047) in patients with renal insufficiency. Multivariate Cox’s proportional hazards analysis including established prognostic parameters, age and GFR confirmed NT-proBNP as an independent risk factor for clinical worsening in PH patients with renal insufficiency (hazard ratio 4.8, p = 0.007). Thus, in a retrospective analysis we showed that NT-proBNP levels correlated with hemodynamic parameters and outcome regardless of renal function. By using higher cut-off values, NT-proBNP seems to represent a valid clinical marker even in PH patients with renal insufficiency.
Prognostic value of brain natriuretic peptide in acute pulmonary embolism
Guillaume Coutance, Olivier Le Page, Ted Lo, Martial Hamon
Critical Care , 2008, DOI: 10.1186/cc6996
Abstract: The authors reviewed PubMed, BioMed Central, and the Cochrane database and conducted a manual review of article bibliographies. Using a prespecified search strategy, we included a study if it used BNP or N-terminal pro-BNP biomarkers as a diagnostic test in patients with documented PE and if it reported death, the primary endpoint of the meta-analysis, in relation to BNP testing. Studies were excluded if they were performed in patients without certitude of PE or in a subset of patients with cardiogenic shock. Twelve relevant studies involving a total of 868 patients with acute PE at baseline were included in the meta-analysis using a random-effects model.Elevated BNP levels were significantly associated with short-term all-cause mortality (odds ratio [OR] 6.57, 95% confidence interval [CI] 3.11 to 13.91), with death resulting from PE (OR 6.10, 95% CI 2.58 to 14.25), and with serious adverse events (OR 7.47, 95% CI 4.20 to 13.15). The corresponding positive and negative predictive values for death were 14% (95% CI 11% to 18%) and 99% (95% CI 97% to 100%), respectively.This meta-analysis indicates that, while elevated BNP levels can help to identify patients with acute PE at high risk of death and adverse outcome events, the high negative predictive value of normal BNP levels is certainly more useful for clinicians to select patients with a likely uneventful follow-up.Accurate risk stratification in patients with pulmonary embolism (PE) is of first importance in selecting the optimal management strategy for each individual and to potentially improve patient outcome [1-12]. Indeed, in-hospital mortality associated with PE depends on clinical features at admission and increases significantly when right ventricular (RV) dysfunction is documented by echocardiography even in the absence of hemodynamic deterioration [11]. Brain natriuretic peptide (BNP) is a neurohormone secreted from cardiac ventricles in response to ventricular strain. It has been suggested that BNP or N-
B-type natriuretic peptide predicts long-term prognosis in a cohort of critically Ill patients  [cached]
Rui Baptista,Elisabete Jorge,Eduardo Sousa,Jorge Pimentel
Heart International , 2011, DOI: 10.4081/hi.2011.e18
Abstract: B-type natriuretic peptide is an important prognostic marker in heart failure. However, there are limited data for its value in non-cardiac intensive care unit patients, namely regarding long-term prognosis. We investigated the long-term prognostic value of BNP in a cohort of critically ill patients. This was a prospective and observational study, conducted in a tertiary university hospital 20-bed intensive care unit. We included 103 mechanically- ventilated patients admitted for a noncardiac primary diagnosis; B-type natriuretic peptide samples were obtained on admission. A mean 14 (3-30) month follow up was available in 96.1% of patients who were discharged from hospital. Mean age was 60.7±19.0 years and mean APACHE II score was 16.2±7.2. APACHE II score and renal dysfunction increased with rising B-type natriuretic peptide, with more than 60% of patients having Btype natriuretic peptide levels of 100 pg/mL or over; echocardiography-derived left ventricular ejection fraction was lower in patients with higher B-type natriuretic peptide (P < 0.001). Long-term survivors had lower median B-type natriuretic peptide values (117.5[2-1668] pg/mL) compared with intensive care unit non-survivors (191.0[5-4945] pg/mL), P<0.001. After adjustment to APACHE II score, B-type natriuretic peptide levels of 300 pg/mL or over were independently associated with long-term mortality (odds-ratio 4.1 [95% CI 1.45-11.5], P=0.008). We conclude that in an unselected cohort of intensive care unit patients, admission B-type natriuretic peptide is frequently elevated, even without clinically apparent acute heart disease, and is a strong independent predictor of long-term mortality.
Prognostic Value of Serum B-Type Natriuretic Peptide in Early Mortality and Morbidity of Children with Congenital Heart Disease after Open Heart Surgery
Avisa Tabib,Ramin Emamzadegan,Hooman Bakhshandeh,Nozar Givtaj
Journal of Tehran University Heart Center , 2009,
Abstract: Background: Brain type natriuretic peptide (BNP) is a cardiac hormone that is secreted mainly by the ventricles in response to volume expansion and pressure load. It can predict post-operative complications after heart surgery in adults. We sought to investigate the prognostic value of BNP in children after heart surgery. Methods: We measured the BNP serum levels in 96 children with congenital heart diseases before, immediately after, and 12 hours after open heart surgery. We studied the ability of the post-operative BNP serum level variations to predict mortality and morbidity in children. Results: In total, 96 patients, comprising 40 (41.7%) females and 56 (58.3%) males with a mean age of 4.1 years (range: 1 month to 17 years), with various congenital heart diseases were studied. The rise in the serum BNP level 12 hours post surgery was directly related to mortality before discharge from hospital (P value=0.004), congestive heart failure after surgery (P value<0.001) , patients' cyanosis (P value=0.045), duration of ICU stay (r=0.342, P value=0.004), and post-operative need for inotropic drugs (P value<0.001). Conclusion: The rise in the BNP serum level 12 hours after heart surgery is a good marker for predicting mortality, morbidity, and early diagnosis of heart failure in children.
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