Changes in B.type Natriuretic Peptide and Related Hemodynamic Parameters Following a Fluid Challenge in Critically Ill Patients with Severe Sepsis or Septic Shock

Omar, Shahed; Ali, Ahmad; Atiya, Yahya; Mathivha, R L; Dulhunty, Joel M.

doi:10.4103/ijccm.ijccm_318_16

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…Вместе с тем есть основания считать, что НУП могут быть взаимосвязаны с параметрами кровообращения в общей популяции больных, в том числе без снижения фракции изгнания ЛЖ, характерного для септической кардио патии. В различные сроки после поступления больных в ОРИТ выявлены корреляции между BNP или NTproBNP и конечно-диастолическим объемом ЛЖ [11,35], заклинивающим давлением в легочной артерии (ДЛА) [14], АДср, сердечным индексом [23], а также эхокардиографическими признаками диастолической дисфункции (характеристики трансмитрального потока) [36]. Последнюю считают наиболее ранним проявлением септической кардиопатии, когда еще нет снижения фракции изгнания ЛЖ [37].…”

Section: Discussionunclassified

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Tyurin¹,

Раутбарт²,

Protsenko³

et al. 2020

PKiK

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Aim. To evaluate the dynamics and prognostic significance of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in patients with severe abdominal sepsis.Methods. We analysed survey data of 54 patients (28 men and 26 women) aged 64.5 years [56.25–78.00] with abdominal sepsis or septic shock. Disease severity scored according to the Acute Physiology and Chronic Health Evaluation II criteria was 16.3 ± 0.8 and according to the Sequential Organ Failure Assessment (SOFA) was 3 [3–6]. Statistical analysis of these data was performed using correlation analysis, logistic regression and receiver operating characteristic analysis.Results. Serum NT-proBNP level during the 1st week following admission to the intensive care unit (ICU) exceeded normal values, i.e. 2,570 [116.25–6,559.5] to 4,600 [1,680–18,200] pg/ml. At all disease stages, serum NT-proBNP level correlated with sepsis severity scores (SOFA), procalcitonin (PCT) levels, lactatemia, mean arterial pressure, heart rate and inotropic and vasoactive–inotropic scales (rho = 0.329–0.433; p < 0.02). On ICU days 3–4, serum NT-proBNP level of >5100 pg/ml was associated with increased risk of mortality [65.6%–88.2%; area under the curve (AUC) = 0.806; р < 0.0001]. Similarly, during this interval, elevated serum NT-proBNP level was associated with the use of inotropic drugs (OR = 1.0001, 95% CI = 1.000–1.0002, p < 0.0059). Notably, we found that 76.9%–79.0% of the patients with serum NT-proBNP level of >5250 pg/ml were receiving inotropic drugs including adrenaline, dopamine and dobutamine. We were unable to identify a specific association between serum NT-proBNP level and norepinephrine administration. On ICU days 7 and 8, among patients with serum NT-proBNP level of >3450 pg/ml, we observed a very close relationship between serum NT-proBNP level and PCT (sensitivity = 63.6%, specificity = 66.7%, AUC = 0.708; р = 0.0041).Conclusion. Serum NT-proBNP level is considerably elevated in patients with abdominal sepsis or septic shock. NT-proBNP level was associated with both traditional indicators of sepsis severity and indicators characterising the state of systemic circulation. Notably, serum NT-proBNP level correlates with cardiac failure and inotropic drug requirement. Although the mechanisms underlying the observed increases in serum NT-proBNP level remain unclear, the present findings indicate that this mediator is clearly a significant biomarker and predictor of adverse outcomes related to abdominal sepsis and septic shock. Received 22 January 2020. Revised 27 January 2020. Accepted 11 February 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and study design: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov Data collection and analysis: I.N. Tyurin, S.A. Rautbart, S.N. Shurygin Statistical analysis: I.N. Tyurin, S.A. Rautbart Drafting the article: I.N. Tyurin, D.N. Protsenko, I.A. Kozlov, S.N. Shurygin Critical revision of the article: I.N. Tyurin, I.A. Kozlov Final approval of the version to be published: I.N. Tyurin, S.A. Rautbart, D.N. Protsenko, S.N. Shurygin, I.A. Kozlov

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Section: Discussionunclassified

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Tyurin¹,

Раутбарт²,

Protsenko³

et al. 2020

PKiK

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“…Repeated fluid challenge administration until the heart is operating on the flat portion of the Frank-Starling curve may potentially lead to tissue/lung edema. Increases in cardiac filling pressures induced by fluid administration stimulates the release of atrial natriuretic peptide by myocardial cells ( 131 ), which is a physiological mechanism whereby the organism promotes elimination of excess fluid. However, it has been demonstrated that increased plasma atrial natriuretic peptide also promotes shedding of the endothelial glycocalyx, which may lead to tissue edema ( 132 ).…”

Section: Controversies Of Gdft and The Risk Of Fluid Overloadmentioning

confidence: 99%

Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies?

Neto

Valverde

2021

Front. Vet. Sci.

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Resuscitative fluid therapy aims to increase stroke volume (SV) and cardiac output (CO) and restore/improve tissue oxygen delivery in patients with circulatory failure. In individualized goal-directed fluid therapy (GDFT), fluids are titrated based on the assessment of responsiveness status (i.e., the ability of an individual to increase SV and CO in response to volume expansion). Fluid administration may increase venous return, SV and CO, but these effects may not be predictable in the clinical setting. The fluid challenge (FC) approach, which consists on the intravenous administration of small aliquots of fluids, over a relatively short period of time, to test if a patient has a preload reserve (i.e., the relative position on the Frank-Starling curve), has been used to guide fluid administration in critically ill humans. In responders to volume expansion (defined as individuals where SV or CO increases ≥10–15% from pre FC values), FC administration is repeated until the individual no longer presents a preload reserve (i.e., until increases in SV or CO are <10–15% from values preceding each FC) or until other signs of shock are resolved (e.g., hypotension). Even with the most recent technological developments, reliable and practical measurement of the response variable (SV or CO changes induced by a FC) has posed a challenge in GDFT. Among the methods used to evaluate fluid responsiveness in the human medical field, measurement of aortic flow velocity time integral by point-of-care echocardiography has been implemented as a surrogate of SV changes induced by a FC and seems a promising non-invasive tool to guide FC administration in animals with signs of circulatory failure. This narrative review discusses the development of GDFT based on the FC approach and the response variables used to assess fluid responsiveness status in humans and animals, aiming to open new perspectives on the application of this concept to the veterinary field.

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“…Brain natriuretic peptides have been found to be associated with cardiac dysfunction in patients with septic shock. 17,18,28,29,32,36,37,39,41,46,[48][49][50][51] Elevated levels of BNP and NT-proBNP have been associated with reduced ejection fraction 17 and stroke volume, 39 global tissue hypoxia, 18 reduced cardiac index, 48 sepsis induced myocardial dysfunction, 50 prior cardiac dysfunction, 37,49,52 diastolic left ventricular size 51 and systolic as well as diastolic dysfunction. 29,32,36 On the contrary, BNP has been found to be a poor predictor of volume status in critically ill patients, including patients with septic shock.…”

Section: Brain Natriuretic Peptides Levels In Respect To Cardiac Fumentioning

confidence: 99%

The utility of brain natriuretic peptides in septic shock as markers for mortality and cardiac dysfunction: A systematic review

et al. 2019

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Objective To conduct a systematic review evaluating the utility of brain natriuretic peptide (BNP) and N‐terminal proBNP (NT‐proBNP) as biomarkers in adult patients with septic shock. Materials and Methods Pubmed/Medline databases were searched from inception to November 2018 using the search terms: (septic[Title/Abstract] AND shock[Title/Abstract]) AND bnp[Title/Abstract]) and (septic[Title/Abstract]) AND shock[Title/Abstract]) AND natriuretic[Title/Abstract]). No restriction was applied regarding date of publication. Comparative observational studies evaluating BNP and NT‐proBNP in patients with septic shock aged ≥18 years were eligible for inclusion. Bibliographies from the extracted articles were also reviewed to identify additional relevant publications. Results In total, 46 studies met all eligibility criteria and were included. A strong body of literature has demonstrated that in patients with septic shock, increased values of BNP and NT‐proBNP are associated with increased mortality. An increase from baseline BNP values has also been associated with increased mortality, whereas decreases from baseline values are not related to worse outcome. Brain natriuretic peptides have also been associated with cardiac dysfunction in patients with sepsis. Moreover, BNP values have been found to be significantly elevated in septic shock, regardless of cardiac dysfunction, and have been used to distinguish between septic and cardiogenic shock. Furthermore, BNP and NT‐proBNP are significantly increased in patients with septic shock, compared to patients with sepsis and severe sepsis. Conclusions BNP and NT‐proBNP appear to be reliable predictors of outcome in septic shock.

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Changes in B.type Natriuretic Peptide and Related Hemodynamic Parameters Following a Fluid Challenge in Critically Ill Patients with Severe Sepsis or Septic Shock

Cited by 7 publications

References 34 publications

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

N-terminal pro-B-type natriuretic peptide is a biomarker of myocardial stress in abdominal sepsis and septic shock

Clinical Application of the Fluid Challenge Approach in Goal-Directed Fluid Therapy: What Can We Learn From Human Studies?

The utility of brain natriuretic peptides in septic shock as markers for mortality and cardiac dysfunction: A systematic review

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