22 Sep 07
Posted in BNP, Critical Care at 18:23 by Laci
By C Mueller
Crit Care Med 2007;35:2438-2439
B-type natriuretic peptides (BNP and NT-pro-BNP) are quantitative markers of cardiac stress and heart failure, summarizing the extent of systolic and diastolic left ventricular dysfunction, valvular dysfunction, and right ventricular dysfunction. They have been shown to be extremely helpful in the diagnosis and prognosis of heart failure, particularly in the emergency department. As the diagnostic dilemmas in the intensive care unit (ICU) are often as challenging as in the emergency department, recent studies have begun to evaluate whether the use of BNP might also be helpful in the ICU. Major differences in patient characteristics, disease severity, comorbidity, resources available for the individual patient, and therapies applied between the ICU and the emergency department require that the potential clinical use of BNP in the ICU be defined by specific ICU studies.
The use of a biomarker to detect heart failure in the ICU is based on the observation that heart failure is common in the ICU and on the assumption that the detection of heart failure in the ICU allows the initiation of specific heart failure therapy or changes in patient management that ultimately might improve patient morbidity and mortality. In critically ill patients, even small improvements in management might have the potential to improve patient outcome.
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Posted in BNP, Critical Care at 18:20 by Laci
By B Meyer, M Huelsmann, P Wexberg, GD Karth, R Berger, D Moertl, T Szekeres, R Pacher, G Heinz, Gottfried
Crit Care Med 2007;35:2268-2273
Natriuretic peptides emerged during recent years as potent prognostic markers in patients with heart failure and acute myocardial infarction. In addition, natriuretic peptides show strong predictive value in patients with pulmonary embolism, sepsis, renal failure, and shock. The present study tests the prognostic information of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in an unselected cohort of critically ill patients.
Design
Prospective, observational study.
Setting
A tertiary intensive care unit in a university hospital.
Patients
A total of 289 consecutive patients admitted to the intensive care unit during a 16-month period with the following data: age 64 +/- 14 yrs, male n = 191, Simplified Acute Physiology Score II of 52 +/- 24, mechanical ventilation n = 180 (62%), vasopressors n = 179 (62%), renal failure n = 24 (8%).
Interventions
None.
Measurements and Main Results
Plasma NT-pro-BNP samples (Roche Diagnostics) were obtained on intensive care unit admission. Data are given as median [range]. Intensive care unit survivors had significantly lower NT-pro-BNP values compared with intensive care unit nonsurvivors (3394 [24-35,000] vs. 6776 [303-35,000] pg/mL, survivors vs. nonsurvivors, respectively, p = .001). Hospital survivors were characterized by significantly lower NT-pro-BNP values (2656 [24-35,000] vs. 8390 [303-35,000] pg/mL, survivors vs. nonsurvivors, respectively, p = .001). NT-pro-BNP levels were not significantly different in patients with primary cardiac diagnosis compared with those with a noncardiac admission diagnosis (4794 [26-35,000], n = 202 vs. 3349 [24-35,000], n = 87, cardiac vs. noncardiac, respectively, p = .28). In a logistic regression model, Simplified Acute Physiology Score II and NT-pro-BNP were independently associated with hospital survival ([chi]2 = 35.6, p = .0001 and [chi]2 = 11.3, p = .0008, Simplified Acute Physiology Score II and NT-pro-BNP, respectively). Areas under the receiver operating characteristic curves of NT-pro-BNP and Simplified Acute Physiology Score II were not statistically significant different regarding the prediction of outcome.
Conclusions
NT-pro-BNP on admission is an independent prognostic marker of outcome in an unselected cohort of critically ill patients. A single measurement of NT-pro-BNP might facilitate triage of emergency and intensive care unit patients.
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28 Aug 07
Posted in Anesthesia, BNP, Pre-operatie evaluation at 19:01 by Laci
By BH Cuthbertson, G Card, BL Croal, J McNeilly, GS Hillis
Anaesthesia 2007;62:875–881
B-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesised that they would identify individuals at increased risk of complications and mortality following major emergency non-cardiac surgery. Forty patients were studied with a primary end-point of a new postoperative cardiac event, and/or development of significant ECG changes, and/or cardiac death. The main secondary outcome was all-cause mortality at 6 months. Pre-operative BNP levels were higher in 11 patients who suffered a new postoperative cardiac event (p = 0.001) and predicted this outcome with an area under the receiver operating characteristic curve of 0.85 (CI = 0.72–0.98, p = 0.001). A pre-operative BNP value > 170 pg.ml-1 has a sensitivity of 82% and a specificity of 79% for the primary end-point. In this small study, pre-operative BNP levels identify patients undergoing major emergency non-cardiac surgery who are at increased risk of early postoperative cardiac events. Larger studies are required to confirm these data.
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17 Aug 07
Posted in Anesthesia, BNP, Heart failure/Cardiogenic shock, Pre-operatie evaluation at 20:23 by Laci
By B. H. Cuthbertson, A. R. Amiri, B. L. Croal, S. Rajagopalan, O. Alozairi, J. Brittenden and G. S. Hillis
British Journal of Anaesthesia 2007;99:170-176
B-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesized that they would identify individuals at increased risk of early cardiac complications after major non-cardiac surgery. The current study tests this hypothesis.
Methods
Two hundred and four patients undergoing major non-cardiac surgery were studied. The primary end-point was the development of acute myocardial injury [defined as cardiac troponin I (cTnI) level > 0.32 ng ml–1] or death in the 3 days after surgery.
Results
Preoperative BNP levels were raised in patients who died or suffered perioperative myocardial injury (median 52.2 vs 22.2 pg ml–1, P = 0.01) and BNP predicted this outcome with an area under the receiver operating characteristic curve of 0.72 [95% confidence interval (CI) 0.59–0.86, P = 0.01]. A preoperative BNP value > 40 pg ml–1 was associated with an increased risk of death or perioperative myocardial injury [odds ratio (OR) 6.8, 95% CI 1.8–25.9, P = 0.003], and remained independently predictive after correction for the Revised Cardiac Risk Index. Preoperative BNP levels were higher in patients who exhibited new onset atrial fibrillation or ST/T-wave changes on their postoperative ECG (median 50.5 vs 22.5 pg litre–1, P = 0.01). They were also higher in patients who had either elevation of cTnI > 0.32 ng ml–1 or postoperative ECG abnormalities (median 50.4 vs 21.5 pg ml–1, P < 0.001).
Conclusions
In the setting of major non-cardiac surgery, preoperative BNP levels are higher in patients who experience perioperative death and myocardial injury. Larger studies are required to confirm these data and to clarify what BNP levels may add to existing methods of risk stratification.
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