Clinical Utility of B-Type Natriuretic Peptide in Early Severe Sepsis and Septic Shock

Journal of Intensive Care Medicine - Tập 22 Số 6 - Trang 363-373 - 2007
Emanuel P. Rivers1, James McCord2, Ronny Otero3, Gordon Jacobsen4, Manisha Loomba5
1Department of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan, Department of Surgery, Henry Ford Hospital, Wayne State University, Detroit, Michigan,
2Department of Cardiology, Henry Ford Hospital, Wayne State University, Detroit, Michigan
3Department of Emergency Medicine, Henry Ford Hospital/Wayne State University, Detroit, Michigan
4Department of Biostatistics and Epidemiology (GJ), Henry Ford Hospital, Wayne State University, Detroit, Michigan
5Department of Anesthesiology, Henry Ford Hospital, Wayne State University Detroit, Michigan

Tóm tắt

B-type natriuretic peptide (BNP) has diagnostic, therapeutic, and prognostic utility in critically ill patients. For severe sepsis and septic shock patients in particular, similar clinical utility from the most proximal aspects of hospital presentation to the intensive care unit has not been examined. BNP levels were measured at 0, 3, 6, 12, 24, 36, 48, 60, and 72 hours in 252 patients presenting to the emergency department with severe sepsis and septic shock. The clinicians were blinded to the BNP levels. Elevated BNP levels (>100 pg/mL) were seen in 42% and 69% of patients on presentation and at 24 hours, respectively. Elevated BNP ranges (>230 pg/mL) were significantly associated with myocardial dysfunction and severity of global tissue hypoxia. When adjusted for age, gender, history of heart failure, renal function, organ dysfunction, and mean arterial pressure, a BNP greater than 210 pg/mL at 24 hours was the most significant independent indicator of increased mortality: odds ratio 1.061 (1.026-1.097), P < .001, 95% confidence interval. Patients with severe sepsis and septic shock often have elevated BNP levels, which are significantly associated with organ and myocardial dysfunction, global tissue hypoxia, and mortality. Serial BNP levels may be a useful adjunct in the early detection, stratification, treatment, and prognostication of high-risk patients.

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Journal of Intensive Care Medicine

Tập 22 Số 6

363-373

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