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 noncardiac
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 Btype
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.
BNP, critical illness, prognosis, mortality.
Rui Baptista Cardiology Department, Coimbra University Hospital and Medical School Praceta Mota Pinto, 3000-001 Coimbra, Portugal. Tel: + 351.918523940. E-mail: ruibaptista@gmail.com
We are indebted to the ICU
nursing staff, for substantial help in blood sample
withdrawal and processing.
2011-05-15T00:00:00
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