Prognostic value of circulating amino-terminal pro-C-type natriuretic peptide in critically ill patients

Koch, Alexander; Voigt, Sebastian; Sanson, Edouard; Dückers, Hanna; Horn, Andreas; Zimmermann, Henning W.; Trautwein, Christian; Tacke, Frank

doi:10.1186/cc10007

Cited by 49 publications

(46 citation statements)

References 36 publications

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“…More recent studies report similar findings using assays of NTproCNP in critically ill adults (16), with values being increased in the presence of sepsis (17). A strong positive association of plasma NTproCNP with inflammatory markers such as CRP was also documented (17). These findings in critically ill adults stand in contrast with the present observations in young children in which acute inflammation, in most instances infectious in origin, suppressed CNP production as shown by greatly reduced plasma concentrations of both CNP forms.…”

Section: Inflammation In Children Inhibits Cnpsupporting

confidence: 81%

“…Notably, adults with severe sepsis and associated shock and multiorgan failure were found to have markedly raised plasma concentrations of CNP (15)-possibly induced by cytokines (such as tumor necrosis factor-α and lipopolysaccharide) and an activated inflammatory state. More recent studies report similar findings using assays of NTproCNP in critically ill adults (16), with values being increased in the presence of sepsis (17). A strong positive association of plasma NTproCNP with inflammatory markers such as CRP was also documented (17).…”

Section: Inflammation In Children Inhibits Cnpmentioning

confidence: 52%

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Acute inflammation in young children inhibits C-type natriuretic peptide

et al. 2013

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Background: C-type natriuretic peptide (CNP) is a paracrine growth factor critical in endochondral bone growth. Amino-terminal CNP (NTproCNP), measurable in plasma, correlates with growth-plate activity and can be used as a biomarker of growth velocity in children. Because severe inflammation in adults increases CNP, we studied CNP peptides and inflammatory markers in children with acute illness. Methods: Forty-two children aged 2 mo to 5 y with acute illness warranting admission to an acute assessment unit were studied. Fifteen age-matched healthy children attending an outpatient clinic served as controls. Venous CNP concentrations were measured at admission, along with markers of acute inflammation (body temperature, C-reactive protein (CRP), and white blood cell count) in children with acute illness. results: NTproCNP and CNP SD scores (SDSs) in the acutely ill group were significantly suppressed (P < 0.001) as compared with those of healthy children or healthy population norms. NTproCNP SDS was significantly inversely related to body temperature (r = −0.42, P < 0.01) and CRP (r = −0.56, P < 0.001). conclusion: Acute inflammation in young children potently reduces CNP production, which needs to be considered when screening for growth disorders. Our data raise the possibility that the adverse effects of inflammatory cytokines on skeletal growth may be mediated in part by reduced CNP. c -type natriuretic peptide (CNP) is expressed in a wide range of tissues (1), but its regulation in vivo has been difficult to study because only small amounts of the active peptide enter the circulation. However, recognition that an inactive amino-terminal fragment of proCNP (NTproCNP) is co-secreted with CNP (2,3), is readily measured in plasma, and correlates with tissue CNP production (4), has opened the door to clinical studies-for example, study of changing CNP production during growth and development.In keeping with evidence showing that an intact CNP signaling pathway is crucial to postnatal endochondral growth (5,6), there is now strong support for the view that plasma concentrations of NTproCNP reflect concurrent linear growth velocity during childhood (3,7,8). Recent studies indicate that plasma NTproCNP concentration accounts for at least 50% of the variation in growth velocity in healthy children aged 2 mo to 20 y (9). Furthermore, changes in growth velocity initiated by hormone therapy (10) or glucocorticoid drugs (11) are closely correlated with concordant changes in plasma NTproCNP. Together, these findings suggest that, provided other pathophysiological variables are controlled, this peptide may be a useful marker of concurrent growth velocity. During the course of determining a provisional reference range for plasma CNP forms, we observed unusually low concentrations in very young children with intercurrent infections. This finding-unexpected in light of reports in adults showing that plasma CNP forms were raised in acute sepsis-raised the possibility that the CNP response to acute inflammation may differ in gro...

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Section: Inflammation In Children Inhibits Cnpsupporting

confidence: 81%

Section: Inflammation In Children Inhibits Cnpmentioning

confidence: 52%

Acute inflammation in young children inhibits C-type natriuretic peptide

et al. 2013

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“…We therefore conducted a large study with critically ill patients in a medical ICU, performing longitudinal measurements of NT-proCNP serum concentrations during the first week of ICU treatment, to address whether NT-proCNP is activated in critical illness, whether NT-proCNP has diagnostic value for sepsis and/or multiorgan failure, and whether NT-proCNP can serve as a prognostic predictor for ICU and long-term survival (Koch et al 2011). This book chapter will mainly summarize and discuss important findings from this study (Koch et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Critically Ill Patients and Circulating Amino-Terminal Pro-C-Type Natriuretic Peptide

Koch¹,

Tacke²

2014

Diet and Nutrition in Critical Care

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The natriuretic peptide family members, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP), exert multiple potent diuretic, natriuretic, and vasorelaxant functions, thereby directly influencing body-fluid homeostasis and blood pressure control. C-type natriuretic peptide (CNP) is mainly synthesized in the vasculature. We have evaluated the diagnostic and prognostic value of N-terminal proCNP (NT-proCNP) in 273 critically ill patients (197 patients with sepsis or septic shock, 76 without evidence of sepsis) in comparison to 43 healthy controls. Critically ill patients displayed significantly elevated NT-proCNP serum concentrations upon admission to the ICU compared to healthy controls, especially in conditions of sepsis. NT-proCNP correlated with inflammatory parameters (i.e., C-reactive protein, procalcitonin, and TNF-a), biomarkers of organ dysfunction, and clinical composite scores (APACHE II, SOFA, SAPS2). Despite its potential involvement in the pathogenesis of critical illness and sepsis, NT-proCNP may also be valuable as a prognostic biomarker in the ICU setting, because NT-proCNP levels at admission and day 3 were found to be predictive for ICU and overall survival. Further studies are warranted to elucidate the underlying pathomechanisms of NT-proCNP in critical illness and to validate its potential as a biomarker at the ICU.

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“…Better understanding of disease pathogenesis has allowed the identification of specific biomarkers that are being used to screen patients at risk for a variety of diseases, as well as to evaluate response to therapy and predict outcome 1. Among others, amino‐terminal pro‐C‐type natriuretic peptide (NT‐proCNP), a stable product of cleavage of C‐type natriuretic peptide (CNP), is a novel biomarker with potential diagnostic utility in sepsis 2, 3, 4…”

mentioning

confidence: 99%

“…Individual and serial serum NT‐proCNP measurements predict sepsis in heterogeneous populations of critically ill and trauma patients 2, 3. There has been limited NT‐proCNP research in veterinary medicine, with 1 study suggesting a potential use of serum NT‐proCNP for the identification of sepsis in dogs 4.…”

mentioning

confidence: 99%

Serial Evaluation of Abdominal Fluid and Serum Amino‐terminal pro‐C‐type Natriuretic Peptide in Dogs with Septic Peritonitis

Guieu

Bersenas

Holowaychuk

et al. 2015

Veterinary Internal Medicne

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BackgroundSerum N‐terminal pro‐C‐natriuretic peptide (NT‐proCNP) has shown promise as a diagnostic biomarker for sepsis. Its sensitivity to detect dogs with septic peritonitis (SP) is reportedly low, perhaps attributable to the compartmentalization of NT‐proCNP in the abdominal cavity.ObjectivesTo evaluate the use of an ELISA for the measurement of NT‐proCNP in canine abdominal fluid and to describe the peri‐operative pattern of abdominal fluid and serum NT‐proCNP concentrations in dogs with SP.AnimalsFive client‐owned dogs with nonseptic abdominal effusion of varying etiologies and 12 client‐owned dogs with SP undergoing abdominal surgery and placement of a closed‐suction abdominal drain (CSAD). Six dogs were included upon hospital admission; 6 were included the day after surgery.MethodsProspective pilot study. A commercially available ELISA kit was analytically validated for use on canine abdominal fluid. The NT‐proCNP concentrations were measured in the abdominal fluid of control dogs, and in serum and abdominal fluid of dogs with SP from admission for CSAD removal.ResultsIn dogs with SP, admission abdominal fluid NT‐proCNP concentrations were lower than the concurrent serum concentrations (P = 0.031), and lower than control canine abdominal fluid concentrations (P = 0.015). Postoperatively, abdominal fluid NT‐proCNP concentrations remained lower than serum concentrations (P < 0.050), except on day 4.Conclusions and Clinical ImportanceThe ELISA kit was able to measure NT‐proCNP in canine abdominal fluid. In dogs with SP, low serum NT‐proCNP concentrations cannot be explained by abdominal compartmentalization.

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Prognostic value of circulating amino-terminal pro-C-type natriuretic peptide in critically ill patients

Cited by 49 publications

References 36 publications

Acute inflammation in young children inhibits C-type natriuretic peptide

Acute inflammation in young children inhibits C-type natriuretic peptide

Critically Ill Patients and Circulating Amino-Terminal Pro-C-Type Natriuretic Peptide

Serial Evaluation of Abdominal Fluid and Serum Amino‐terminal pro‐C‐type Natriuretic Peptide in Dogs with Septic Peritonitis

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