B‐Type natriuretic peptide and the prediction of outcome in patients admitted to intensive care

Cuthbertson, Brian H.; Patel, Rashmi; Croal, Bernard; Barclay, Justin L.; Hillis, Graham S.

doi:10.1111/j.1365-2044.2004.03972.x

Cited by 50 publications

(47 citation statements)

References 36 publications

(30 reference statements)

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“…In such an unselected ICU population, the clinical spectrum is wide and nonspecific. In other studies on the use of natriuretic peptides in intensive care, focus has been on specific groups of patients (60,63,68,93), and studies on NT-proBNP in general ICU populations preceding study I have been more limited in size (70)(71)(72)94). Although direct comparison between studies is complicated by differences in patient selection, the results of study I are in the same range as in preceding studies.…”

Section: Patient Selection and Settings (Papers I -Iv)supporting

confidence: 64%

“…We found that NT-proBNP levels close to the thresholds used clinically, and reported in other studies (70,71,94), could predict death in general intensive care patients. Statistically, the predictive ability of NT-proBNP was independent of age, ICU LOS and the presence of sepsis.…”

Section: On Predicting Cardiac Outcome In Icu Patients (Papers I -Iv)supporting

confidence: 57%

“…While demonstrating a predictive value of NT-proBNP in general ICU patients, this thesis does not support the use of NT-proBNP as a replacement for other prognostic markers, laboratory or clinical variables and scoring systems alike, in intensive care clinical practice. NT-proBNP may instead be an aid in identifying the most severely ill with the highest risk of death, irrespective of cause (68,70,71,94). As outlined previously in this discussion, an elevated NT-proBNP does not necessarily reflect cardiac failure in intensive care patients, but may rather be a marker of disease severity.…”

Section: On Predicting Cardiac Outcome In Icu Patients (Papers I -Iv)mentioning

confidence: 98%

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Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU admission and was repeated during and after ICU stay. Measurements of cardiac strain using speckle tracking echocardiography were assessed in relation to other echocardiographic function parameters, NT-proBNP and severity of illness scores, and their change over time was analysed. Echocardiograms from patients with septic shock were independently evaluated by two physicians and the results analysed regarding measurement variability. A nationwide-registry-based open cohort of 9,520 severe sepsis and septic shock ICU patients discharged alive from the ICU was analysed together with a non-septic control group matched for age, sex and severity of illness. In patients who died after ICU discharge, information on causes of death was collected. Results: A discriminatory level of significance of NT-proBNP on ICU admission was identified at ≥1,380 ng/L, above which NT-proBNP was an independent predictor of death. With increasing levels of NT-proBNP, patients were more severely ill, had a longer ICU stay and were more often admitted with septic shock. Cardiac strain was frequently impaired in septic shock patients but was not superior to other echocardiographic measurements in detecting cardiac dysfunction. Cardiac strain correlated with other echocardiographic function parameters and with NT-proBNP, and was the least user-dependent echocardiographic parameter in septic shock patients. Cardiac strain remained unchanged over time, did not differ between survivors and non-survivors and could not predict an increased risk of death. During a follow-up of up to nearly 6 years after ICU discharge, 3,954 (42%) of sepsis patients died, 654 (17%) with cardiac failure as the cause of death. With increasing severity of illness on admission, the risk of death with cardiac failure as the cause of death after ICU discharge increased. In comparison to other ICU patients with similar severity of illness, however, the risk of death due to cardiac was not increased in patients with severe sepsis or septic shock. Conclusions: Laboratory or echocardiographic si...

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Section: Patient Selection and Settings (Papers I -Iv)supporting

confidence: 64%

Section: On Predicting Cardiac Outcome In Icu Patients (Papers I -Iv)supporting

confidence: 57%

Section: On Predicting Cardiac Outcome In Icu Patients (Papers I -Iv)mentioning

confidence: 98%

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Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Geer

2016

Linköping University Medical Dissertations

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“…There is also a growing body of literature suggesting a prognostic role for BNP and its derivatives at the time of cardiac surgery [14,15]. In contrast, the role of BNP in predicting risk associated with critical illness is less clear [31][32][33].…”

Section: Prior Studiesmentioning

confidence: 99%

The utility of B‐type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non‐cardiac surgery

et al. 2007

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SummaryB-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. Preoperative 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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“…A prognostic impact of BNP was found by other authors 17,30 . In contrast, a recent study analyzing 78 patients who had been admitted to a general ICU (35 patients with sepsis) revealed higher BNP levels in survivors as compared to nonsurvivors, the same trend being observed when analysis was restricted to the patients with sepsis 31 . Other studies did not find any prognostic information from BNP levels in critically ill patients 32 .…”

Section: Discussionmentioning

confidence: 41%

Influência da pressão expiratória final positiva (PEEP) e da função renal sobre o nível de peptídeo natriurético tipo B em pacientes com sepse grave e choque séptico

Issa¹,

Taniguchi²,

Park³

et al. 2008

Arq. Bras. Cardiol.

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B‐Type natriuretic peptide and the prediction of outcome in patients admitted to intensive care

Cited by 50 publications

References 36 publications

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

The utility of B‐type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non‐cardiac surgery

Influência da pressão expiratória final positiva (PEEP) e da função renal sobre o nível de peptídeo natriurético tipo B em pacientes com sepse grave e choque séptico

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