Positive end-expiratory pressure and renal function influence B-type natriuretic peptide in patients with severe sepsis and septic shock

Victor Sarli Issa, Leandro Utino Taniguchi, Marcelo Park, Luiz Monteiro Cruz, Edimar Alcides Bocchi, Irineu Tadeu Velasco, Francisco Soriano
Arquivos Brasileiros de Cardiologia 2008, 91 (2): 107-12

BACKGROUND: Myocardial dysfunction is a complication associated with a poor prognosis in septic patients. A biomarker of cardiac function providing prognostic information is of paramount interest.

OBJECTIVE: We sought to determine the value of B-type natriuretic peptide in patients with severe sepsis/septic shock.

METHODS: We performed a prospective study in patients with severe sepsis/septic shock in a medical intensive care unit. B-type natriuretic peptide level was determined within 24 hours after the diagnosis of severe sepsis/septic shock. We also analyzed mortality, and presence of association between B-type natriuretic peptide and clinical, hemodynamic and respiratory variables.

RESULTS: 23 (9 women; 14 men) patients with ages ranging from 20-79 (mean 51.3+/-18.6) years old and APACHE score of 22.6+/-11.8 were included; 15 (65.2%) patients received pulmonary artery catheters, and 20 (87%) were mechanically ventilated. Multivariate analysis disclosed inverse association between B-type natriuretic peptide values with positive end-expiratory pressure values, and direct association with creatinine (beta 0.548 and 0.377, p 0.02 and 0.002, respectively), but not with mortality, clinical and hemodynamic parameters.

CONCLUSION: This is the first report on an inverse association between positive end-expiratory pressure and BNP levels in patients with severe sepsis and septic shock. BNP and creatinine levels should be taken into consideration when analyzing B-type natriuretic peptide levels in this setting.

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