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Clinical Utility of B-Type Natriuretic Peptide in Early Severe Sepsis and Septic Shock

Department of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan, Department of Surgery, Henry Ford Hospital, Wayne State University, Detroit, Michigan, erivers1{at}hfhs.org

James McCord, MD

Department of Cardiology, Henry Ford Hospital, Wayne State University, Detroit, Michigan

Ronny Otero, MD

Department of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan

Gordon Jacobsen, MS

Department of Biostatistics and Epidemiology (GJ), Henry Ford Hospital, Wayne State University, Detroit, Michigan

Manisha Loomba, MD

Department of Anesthesiology, Henry Ford Hospital, Wayne State University Detroit, Michigan

B-type natriuretic peptide (BNP) has diagnostic, therapeutic, and prognostic utility in critically ill patients. For severe sepsis and septic shock patients in particular, similar clinical utility from the most proximal aspects of hospital presentation to the intensive care unit has not been examined. BNP levels were measured at 0, 3, 6, 12, 24, 36, 48, 60, and 72 hours in 252 patients presenting to the emergency department with severe sepsis and septic shock. The clinicians were blinded to the BNP levels. Elevated BNP levels (>100 pg/mL) were seen in 42% and 69% of patients on presentation and at 24 hours, respectively. Elevated BNP ranges (>230 pg/mL) were significantly associated with myocardial dysfunction and severity of global tissue hypoxia. When adjusted for age, gender, history of heart failure, renal function, organ dysfunction, and mean arterial pressure, a BNP greater than 210 pg/mL at 24 hours was the most significant independent indicator of increased mortality: odds ratio 1.061 (1.026-1.097), P < .001, 95% confidence interval. Patients with severe sepsis and septic shock often have elevated BNP levels, which are significantly associated with organ and myocardial dysfunction, global tissue hypoxia, and mortality. Serial BNP levels may be a useful adjunct in the early detection, stratification, treatment, and prognostication of high-risk patients.

Key Words: B-type natriuretic peptide • sepsis • severe sepsis • septic shock • myocardial dysfunction • global tissue hypoxia • organ dysfunction • critical illness

Journal of Intensive Care Medicine, Vol. 22, No. 6, 363-373 (2007)
DOI: 10.1177/0885066607307523


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