Brain natriuretic peptide: a potential marker for mortality in septic shock

Abstract

Brain natriuretic peptide (BNP) is a diagnostic marker for left ventricular dysfunction. Sepsis and septic shock are increasing in incidence and mortality. Myocardial dysfunction frequently accompanies severe sepsis and septic shock. Although previously described as a preterminal event, ventricular dysfunction with reduced ejection fraction and biventricular dilatation is present in most patients with severe sepsis and septic shock. In survivors, this depression in cardiac function is reversible over the course of seven to ten days. Even though some prognostic factors have been identified in patients with sepsis-induced myocardial dysfunction, their measurement often includes costly and cumbersome techniques. Thus, there is a need for an inexpensive, simple, rapid and readily available marker to predict mortality in septic shock. At present, a relationship between BNP with myocardial dysfunction in septic shock has not been evaluated. However, growing evidence supports the hypothesis that BNP could be an early predictor of mortality in septic shock. If proven, the hypothesis would have important clinical and public health implications.

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“…Serum BNP levels have been reported to be higher in nonsurvivors on days 2 and 3 as compared with survivors of septic shock (15). In contrast, the study demonstrating higher serum BNP levels in survivors suggests that it is ventricular dilation and decrease in biventricular ejection fraction that is responsible for increased plasma BNP (19). Furthermore in the latter study, BNP levels return to normal as the patient gets better within the first 10 to 14 days.…”

“…Will this knowledge change our treatment? We know that heparin coating of central catheters can decrease the risk for thrombotic complications (18,19). So, our choice of catheters makes a difference, although for a short while, probably 5 to 7 days.…”

B-Type Natriuretic Peptide

“…Thus, a readily measurable circulating biomarker would facilitate the assessment and perhaps prevent cardiovascular dysfunction in these patients. 11 To our knowledge, only 1 retrospective study 14 has shown a relationship between an increase in BNP levels and septic shock. Other studies 15,16 have examined N-terminal (NT) prohormone forms of atrial natriuretic peptide (ANP) (NT-proANP) and BNP (NT-proBNP) as potential markers for sepsis.…”

“…Severe sepsis has been reported to cause more than 200 000 deaths per year, most of which are attributed to cardiovascular collapse. 11 Patients with septic shock were shown to have reversible left ventricular systolic dysfunction with an associated elevation in cardiac index. 12 It was also de-termined that myocardial depression persists in patients with septic shock until death or recovery.…”

Brain Natriuretic Peptide Levels in Pediatric Cancer Patients with Febrile Neutropenia

“…In many studies, clinical investigations and echocardiography have demonstrated cardiac dysfunction in cases of sepsis and septic shock [7,8]. It has been reported that the resultant heart failure and cardiac dysfunction worsen the prognosis of the patients [9].…”