High circulating N-terminal pro-B-type natriuretic peptide is associated with greater systolic cardiac dysfunction and nonresponsiveness to fluids in septic vs nonseptic critically ill patients

Journal of Critical Care
Koen J HarteminkA B Johan Groeneveld

Abstract

It is still unclear whether circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflect cardiac filling and function in the critically ill patient, particularly during sepsis and a proinflammatory response that may induce NT-proBNP release from the heart. We prospectively evaluated the value of NT-proBNP as a marker of cardiac loading, function, and response to fluid loading in 18 septic and 68 nonseptic, critically ill patients in the intensive care unit of a university medical center. Transpulmonary thermal dilution and pressure measurements were done, and plasma NT-proBNP was determined before and after colloid fluid loading. Compared with nonseptic patients, NT-proBNP plasma levels were higher and systolic cardiac function indices were lower in patients with sepsis than those without sepsis. N-terminal pro-B-type natriuretic peptide best related, from all hemodynamic parameters before and after fluid loading, to systolic cardiac function (rather than diastolic filling) variables, independently of confounders such as renal dysfunction (judged from serum creatinine). In addition, a high NT-proBNP (>3467 pg/mL) predicted absence of fluid responsiveness in sepsis only. Our data suggest that an increased ...Continue Reading

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Citations

Jan 20, 2012·Critical Care : the Official Journal of the Critical Care Forum·Feilong WangJunbo Ge
Dec 20, 2012·Journal of Transplantation·Tsuneo Ogawa, Adolfo J de Bold
Jan 3, 2013·The Laryngoscope·Dirk A E Dietz de LoosWytske J Fokkens
Oct 29, 2013·BMC Infectious Diseases·Johan RasmusonClas Ahlm
Mar 17, 2012·Current Opinion in Infectious Diseases·Christoph LichtensternMarkus A Weigand
Feb 6, 2013·Southern Medical Journal·Pramod Reddy, Rohan Samson

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