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Han SS, Bae E, Song SH, Kim DK, Kim YS, Han JS, Joo KW. NT-proBNP Is Predictive of the Weaning from Continuous Renal Replacement Therapy. TOHOKU J EXP MED 2016; 239:1-8. [DOI: 10.1620/tjem.239.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Eunjin Bae
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
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King C, May CW, Williams J, Shlobin OA. Management of right heart failure in the critically ill. Crit Care Clin 2015; 30:475-98. [PMID: 24996606 DOI: 10.1016/j.ccc.2014.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Right ventricular failure complicates several commonly encountered conditions in the intensive care unit. Right ventricular dilation and paradoxic movement of the interventricular septum on echocardiography establishes the diagnosis. Right heart catheterization is useful in establishing the specific cause and aids clinicians in management. Principles of treatment focus on reversal of the underlying cause, optimization of right ventricular preload and contractility, and reduction of right ventricular afterload. Mechanical support with right ventricular assist device or veno-arterial extracorporeal membrane oxygenation can be used in select patients who fail to improve with optimal medical therapy.
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Affiliation(s)
- Christopher King
- Medical Critical Care Service, Inova Fairfax Hospital, 618 South Royal Street, Alexandria, VA 22314, USA.
| | - Christopher W May
- Advanced Heart Failure and Cardiac Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Jeffrey Williams
- Medical Critical Care Service, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Oksana A Shlobin
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
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Koksal GM, Dikmen Y, Esquinas AM. Brain Natriuretic Peptide and Fluid Restrictive Approaches to Prevent Ventilator-Associated Pneumonia. Chest 2015; 147:e63. [DOI: 10.1378/chest.14-1792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Somasundaram K, Ball J. Medical emergencies: atrial fibrillation and myocardial infarction. Anaesthesia 2012; 68 Suppl 1:84-101. [DOI: 10.1111/anae.12050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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[Acute heart failure]. Med Klin Intensivmed Notfmed 2012; 107:397-423; quiz 424-5. [PMID: 22689257 DOI: 10.1007/s00063-012-0118-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 01/10/2023]
Abstract
Acute decompensated heart failure (ADHF) is a major public health problem throughout the world and its importance is continuing to grow. More than 50% of ADHF patients have coronary artery disease, which is generally associated with a history of hypertension. Recent data suggest that half of the patients presenting with acute heart failure have preserved left ventricular systolic function. The diagnosis of ADHF may be difficult at times, and the clinical assessment and patient profiling is essential for appropriate therapy. Immediate therapeutic goals are not only to improve symptoms, restore oxygenation and stabilize hemodynamic conditions, but also to improve short- and long-term survival. In addition to general supportive measures such as oxygen supplementation, noninvasive ventilation, analgesia, diuretics, vasodilators together with inotropic agents and/or vasopressors remain the cornerstone of therapy in patients with ADHF.
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McLean AS, Huang SJ. Cardiac biomarkers in the intensive care unit. Ann Intensive Care 2012; 2:8. [PMID: 22397488 PMCID: PMC3313856 DOI: 10.1186/2110-5820-2-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 03/07/2012] [Indexed: 11/10/2022] Open
Abstract
Cardiac biomarkers (CB) were first developed for assisting the diagnosis of cardiac events, especially acute myocardial infarction. The discoveries of other CB, the better understanding of cardiac disease process and the advancement in detection technology has pushed the applications of CB beyond the 'diagnosis' boundary. Not only the measurements of CB are more sensitive, the applications have now covered staging of cardiac disease, timing of cardiac events and prognostication. Further, CB have made their way to the intensive care setting where their uses are not just confined to cardiac related areas. With the better understanding of the CB properties, CB can now help detecting various acute processes such as pulmonary embolism, sepsis-related myocardial depression, acute heart failure, renal failure and acute lung injury. This article discusses the properties and the uses of common CB, with special reference to the intensive care setting. The potential utility of "multimarkers" approach and microRNA as the future CB are also briefly discussed.
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Affiliation(s)
- Anthony S McLean
- Department of Intensive Care Medicine, Nepean Hospital, Sydney Medical School, Penrith, NSW 2750, Australia.
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Abstract
Either B-type natriuretic peptide (BNP) or NT-proBNP may be used as a diagnostic, screening, prognostic and therapeutic tool for CHF. The Food and Drug Administration (FDA) cleared the cut-off point for BNP at 100 pg/mL, and that of NT-proBNP at 125 pg/mL for patients <75 years and 450 pg/mL for those >75. A steadily rising titre even below the cut-off value should be raised as a concern as heart failure is progressive if left untreated and may result in cardiac death. Both biomarkers are also featured in lab investigations for patients with acute coronary syndrome (ACS).
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Affiliation(s)
| | - Soon Kieng Phua
- Department of Lab Medicine, Changi General Hospital, Singapore
| | - Tar Choon Aw
- Department of Lab Medicine, Changi General Hospital, Singapore
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Baptista R, Jorge E, Sousa E, Pimentel J. B-type natriuretic peptide predicts long-term prognosis in a cohort of critically ill patients. Heart Int 2011; 6:e18. [PMID: 22355485 PMCID: PMC3282435 DOI: 10.4081/hi.2011.e18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 09/19/2011] [Indexed: 02/06/2023] Open
Abstract
B-type natriuretic peptide is an important prognostic marker in heart failure. However, there are limited data for its value in non-cardiac intensive care unit patients, namely regarding long-term prognosis. We investigated the long-term prognostic value of BNP in a cohort of critically ill patients. This was a prospective and observational study, conducted in a tertiary university hospital 20-bed intensive care unit. We included 103 mechanically-ventilated patients admitted for a non-cardiac primary diagnosis; B-type natriuretic peptide samples were obtained on admission. A mean 14 (3–30) month follow up was available in 96.1% of patients who were discharged from hospital. Mean age was 60.7±19.0 years and mean APACHE II score was 16.2±7.2. APACHE II score and renal dysfunction increased with rising B-type natriuretic peptide, with more than 60% of patients having B-type natriuretic peptide levels of 100 pg/mL or over; echocardiography-derived left ventricular ejection fraction was lower in patients with higher B-type natriuretic peptide (P < 0.001). Long-term survivors had lower median B-type natriuretic peptide values (117.5[2–1668] pg/mL) compared with intensive care unit non-survivors (191.0[5–4945] pg/mL), P<0.001. After adjustment to APACHE II score, B-type natriuretic peptide levels of 300 pg/mL or over were independently associated with long-term mortality (odds-ratio 4.1 [95% CI 1.45–11.5], P=0.008). We conclude that in an unselected cohort of intensive care unit patients, admission B-type natriuretic peptide is frequently elevated, even without clinically apparent acute heart disease, and is a strong independent predictor of long-term mortality.
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Okkonen M, Varpula M, Linko R, Perttilä J, Varpula T, Pettilä V. N-terminal-pro-BNP in critically ill patients with acute respiratory failure: a prospective cohort study. Acta Anaesthesiol Scand 2011; 55:749-57. [PMID: 21480833 DOI: 10.1111/j.1399-6576.2011.02439.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in unselected critically ill patients with acute respiratory failure (ARF). METHODS Prospective, observational cohort study in 25 intensive care units in Finland. This study included a total of 602 patients with laboratory samples from 958 consecutive patients with ARF treated either with invasive or with non-invasive ventilatory support (the FINNALI study). Plasma NT-pro-BNP samples were drawn after the onset of ventilatory support (day 0) and on the morning of the second day. RESULTS The median [interquartile ranges (IQR)] NT-pro-BNP-values were significantly higher at baseline in 90-day non-survivors than the survivors, 4378 pg/ml (1400-13,943 pg/ml) vs. 1052 pg/ml (232-4076 pg/ml), respectively. The median (IQR) NT-pro-BNP values were significantly higher in patients with chronic cardiac disease or cardiac surgery than in non-cardiac patients, 1947 pg/ml (801-4687 pg/ml) vs. 417 pg/ml (153-1735 pg/ml), respectively, if renal function was normal. With deteriorating renal function, the NT-pro-BNP values showed a significant increase. The area under curve for baseline NT-pro-BNP predicting 90-day mortality was moderate: 0.718 (95% confidence interval 0.674-0.761). Baseline NT-pro-BNP over 1765 pg/ml was independently associated with 90-day mortality by logistic regression analysis (P<0.001). CONCLUSIONS NT-pro-BNP on admission is commonly elevated and independently associated with 90-day mortality in critically ill ARF patients. However, the routine use of NT-pro-BNP for prognostic purpose does not seem to add value to clinical data in ARF patients.
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Affiliation(s)
- M Okkonen
- Department of Anaesthesia and Intensive Care Medicine, Division of Surgery, Helsinki University Central Hospital, Finland
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Wang F, Pan W, Pan S, Wang S, Ge Q, Ge J. Usefulness of N-terminal pro-brain natriuretic peptide and C-reactive protein to predict ICU mortality in unselected medical ICU patients: a prospective, observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R42. [PMID: 21272380 PMCID: PMC3221971 DOI: 10.1186/cc10004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/13/2011] [Accepted: 01/28/2011] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The performance of N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) to predict clinical outcomes in ICU patients is unimpressive. We aimed to assess the prognostic value of NT-proBNP, CRP or the combination of both in unselected medical ICU patients. METHODS A total of 576 consecutive patients were screened for eligibility and followed up during the ICU stay. We collected each patient's baseline characteristics including the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, NT-proBNP and CRP levels. The primary outcome was ICU mortality. Potential predictors were analyzed for possible association with outcomes. We also evaluated the ability of NT-proBNP and CRP additive to APACHE-II score to predict ICU mortality by calculation of C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. RESULTS Multiple regression revealed that CRP, NT-proBNP, APACHE-II score and fasting plasma glucose independently predicted ICU mortality (all P < 0.01). The C-index with respect to prediction of ICU mortality of APACHE II score (0.82 ± 0.02; P < 0.01) was greater than that of NT-proBNP (0.71 ± 0.03; P < 0.01) or CRP (0.65 ± 0.03; P < 0.01) (all P < 0.01). As compared with APACHE-II score (0.82 ± 0.02; P < 0.01), combination of CRP (0.83 ± 0.02; P < 0.01) or NT-proBNP (0.83 ± 0.02; P < 0.01) or both (0.84 ± 0.02; P < 0.01) with APACHE-II score did not significantly increase C-index for predicting ICU mortality (all P > 0.05). However, addition of NT-proBNP to APACHE-II score gave IDI of 6.6% (P = 0.003) and NRI of 16.6% (P = 0.007), addition of CRP to APACHE-II score provided IDI of 5.6% (P = 0.026) and NRI of 12.1% (P = 0.023), and addition of both markers to APACHE-II score yielded IDI of 7.5% (P = 0.002) and NRI of 17.9% (P = 0.002). In the cardiac subgroup (N = 213), NT-proBNP but not CRP independently predicted ICU mortality and addition of NT-proBNP to APACHE-II score obviously increased predictive ability (IDI = 10.2%, P = 0.018; NRI = 18.5%, P = 0.028). In the non-cardiac group (N = 363), CRP rather than NT-proBNP was an independent predictor of ICU mortality. CONCLUSIONS In unselected medical ICU patients, NT-proBNP and CRP can serve as independent predictors of ICU mortality and addition of NT-proBNP or CRP or both to APACHE-II score significantly improves the ability to predict ICU mortality. NT-proBNP appears to be useful for predicting ICU outcomes in cardiac patients.
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Affiliation(s)
- Feilong Wang
- Department of Emergency, Xinhua Hospital of Shanghai Jiaotong University, NO 1665, Kongjiang Road, Shanghai 200092, PR China
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The role of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) as a prognostic marker in older people: the impact of reduced renal function. ACTA ACUST UNITED AC 2009. [DOI: 10.1017/s0959259809990189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
SummaryThe N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is released in response to volume expansion and/or increased tension on left ventricular myocytes. NT-pro-BNP is a useful diagnostic and prognostic biomarker both in patients with dyspnoea of unknown aetiology, and for risk assessment of patients with established heart failure. However, impaired kidney function – a common condition in older people as well as a strong risk factor for cardiovascular disease is associated with elevated circulating levels of NT-pro-BNP. Therefore, it is important to know the kidney function when interpreting an elevated NT-pro-BNP measurement obtained in older people in order to diagnose or stage congestive heart failure.
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Meaudre E, Jego C, Kenane N, Montcriol A, Boret H, Goutorbe P, Habib G, Palmier B. B-type natriuretic peptide release and left ventricular filling pressure assessed by echocardiographic study after subarachnoid hemorrhage: a prospective study in non-cardiac patients. Crit Care 2009; 13:R76. [PMID: 19454040 PMCID: PMC2717439 DOI: 10.1186/cc7891] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 05/09/2009] [Accepted: 05/20/2009] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Serum B-type natriuretic peptide (BNP) is frequently elevated after subarachnoid hemorrhage (SAH), but whether this high BNP level is related to transient elevation of left ventricular filling pressure (LVFP) is unknown. However, in patients with preexistent cardiac pathologies, it is impossible to differentiate between BNP elevation caused by chronic cardiac abnormalities and BNP related to acute neurocardiac injury. METHODS All adult patients with SAH admitted to our intensive care unit were eligible. Patients were excluded for the following reasons: admission >48 hours after aneurysm rupture, pre-existing hypertension, or cardiac disease. Levels of BNP and cardiac troponin Ic were measured daily for 7 days. Echocardiography was performed by a blinded cardiologist on days 1, 2, and 7. Doppler signals from the mitral inflow, tissue Doppler, and the color M-mode-derived flow propagation velocity (FPV) were obtained to assess echo-estimated LVFP. RESULTS During a 3-year period, sixty-six consecutive patients with SAH were admitted. Thirty one patients were studied. The BNP level was >100 ng/L in 25 patients (80%) during the first 3 days, with a peak on day 2 (median, 126 ng/L) followed by a gradual decrease (median variation days 1 to 7, 70%). All patients had an ejection fraction >50%. Early transmitral velocity/tissue Doppler mitral annular early diastolic velocity was low: 5.4 (+/- 1.5) on day 1, 5.8 (+/- 1.2) on day 2, and 5.1 (+/- 0.9) on day 7. Early transmitral velocity/FPV was also low: 1.27 (+/- 0.4), 1.25 (+/- 0.3), and 1.1 (+/- 0.2) on days 1, 2, and 7, respectively. Cardiac troponin Ic levels ranged from 0 to 3.67 microg/L and were correlated with BNP (r = 0.63, P < 0.01). CONCLUSIONS BNP rises gradually over two days and return to normal within a week after SAH. Its release is associated with myocardial necrosis, but is unrelated to elevated LVFP assessed by echocardiography.
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Affiliation(s)
- Eric Meaudre
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Christophe Jego
- Department of Cardiology, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Nadia Kenane
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Ambroise Montcriol
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Henry Boret
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Philippe Goutorbe
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Gilbert Habib
- Department of Cardiology, Centre Hospitalo-Universitaire de la Timone, 264 Rue Saint-Pierre, Marseille, 13385, Cedex 5, France
| | - Bruno Palmier
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
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