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Ventricular fibrillation (VF) is characterized by rapid (>300 beats a per minute), irregular electrical activation with variable electrocardiographic waveforms that prevents coordinated myocardial contraction, resulting in immediate loss of cardiac output.1 It most commonly occurs in the context of coronary artery disease.2,3 Resuscitation efforts are critically time-dependent: with each minute of untreated VF, the survival rate declines […]

B-type natriuretic peptide predicts long-term prognosis in a cohort of critically ill patients

Rui Baptista, Elisabete Jorge, Eduardo Sousa, Jorge Pimentel
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Published Online: Aug 7th 2018 Heart International 2011;6(2):e18 DOI: https://doi.org/10.4081/hi.2011.e18
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Abstract

Overview

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.

Keywords

BNP, critical illness, prognosis, mortality.

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Article Information

Correspondence

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

Acknowledgements

We are indebted to the ICU
nursing staff, for substantial help in blood sample
withdrawal and processing.

Received

2011-05-15T00:00:00

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