Prognostic value of natriuretic peptides in severe trauma patients with multiple organ dysfunction syndrome

摘要

The aim of the present study was to evaluate the prognostic values of the N-terminal peptide of pro-atrial natriuretic peptide (NT-proANP) and the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) in severe trauma patients developing multiple organ dysfunction syndrome (MODS). Out of the 126 severe trauma patients that were admitted to the Emergency Intensive Care Unit of the General Hospital of Shenyang Military Region between January 2009 and December 2011, 26 patients with multiple injuries and an injury severity score (ISS) of > 16 points were included in the study. The MODS score was calculated on admission as well as 24, 48 and 72 h after the injury. Patients were divided into two groups: Group A consisted of patients with minor signs of organ dysfunction (MODS score, <= 4 points) and group B of patients with major organ dysfunction (MODS score, > 4 points). Venous blood (5 ml) was extracted from the patients on admission and 6, 12, 24, 48 and 72 h after the injury. The Elecsys proBNP (R) and proANP (R) assays were used to determine the NT-proBNP and NT-proANP levels, respectively. The changes in the levels of C-reactive protein, white blood cells and neutrophils were detected and analyzed on admission. Acute physiology and chronic health evaluation . scores and ISSs were collected 72 h after the injury. The hemodynamic monitoring of cardiac index (CI) was performed using The Pulse index Continuous Cardiac Output system. The serum NT-proANP and NT-proBNP concentrations were elevated in all 26 patients. Upon admission, the serum NT-proANP and NT-proBNP values were 637.3 +/- 8.9 and 137.3 +/- 8.9 pmol/l, respectively, in group A and 1,185.0 +/- 7.2 and 185.0 +/- 7.2 pmol/l, respectively, in group B. The NT-proANP and NT-proBNP levels in group A were significantly lower than those in group B at all subsequent time-points (P< 0.001). By contrast, the CI in group A was significantly higher than that in group B at all time-points (P< 0.001). An inverse correlation was observed between the NT-proANP or NT-proBNP concentration and CI at 24, 48 and 72 h after the injury (r= -0.679 and -0.772, respectively; P< 0.001). In conclusion, the serum NT-proANP and NT-proBNP concentrations following multiple injuries have been found to be significantly correlated with the clinical signs of MODS, and a distinct correlation has been observed between the levels of serums NT-proANP and NT-proBNP and decreased CI. The data of this pilot study suggest that NT-proANP and NT-proBNP levels may be of value in the diagnosis of post-traumatic cardiac impairment.