A prospective study into the use of NT-proBNP measurements in critically ill patients

摘要

Objective: B-type natriuretic peptide (BNP) has been shown to be a sensitive marker of cardiac dysfunction and to increase in patients with septic shock. This study seeks to confirm these findings in a mixed group of critically ill patients.Design and setting: Prospective observational study in a general intensive care unit (ITU) of a university hospital.Patients and participants: Ninety-three consecutive admissions to the general ITU. Interventions: Measurement of NT-proBNP on admission and then daily thereafter. Collection of clinical and demographical data in relation to NT-proBNP over a period of 5 days and outcome data at 28 days and hospital discharge.Measurements and results: NT-proBNP levels were raised for the whole population at each time point. NT-proBNP levels were higher in non-survivors than in survivors from ITU (p = 0.02), at 28 days (p = 0.02) or hospital discharge (p = 0.0004). NT-proBNP was raised in patients with sepsis (11688 (6140-20434) vs. 767 (472-2267) ng/L, p = < 0.0001), cardiac dysfunction (7336 (3383-14906) vs. 757 (428-1819) ng/L, p= < 0.0001), requirement for vasoactive therapy (7151 (1089-14318) vs. 1257 (721-3127) ng/L, p= 0.01) and renal support (12128 (2693-25831) vs. 1687 (752-3291) ng/L, p - < 0.0001). Multiple regression analysis demonstrated that independent predictors of raised NT-proBNP levels were the diagnosis of sepsis (p < 0.0001) or ongoing cardiac dysfunction (p - 0.006).Conclusions: NT-proBNP levels are raised in critically ill patients. The cause of these increases relates to either sepsis or cardiac dysfunction.