Dynamics of brain natriuretic peptide in critically ill patients with severe sepsis and septic shock.

Purpose: Changes of B-type natriuretic peptide (BNP) in sepsis and its utility in predicting intensive care unit outcomes remains a conflicting issue. To investigate the changes in plasma levels of BNP in patients with severe sepsis/septic shock and to study the association of BNP levels with the severity of the disease and prognosis of those patients.

Methods: Thirty patients with severe sepsis or septic shock were enrolled in our study. BNP measurements and echocardiography were carried out on admission and on 4(th) and 7(th) days. Blood concentrations of BNP were measured by commercially available assays (Abbott methods). In-hospital mortality and length of stay were recorded multivariate analyses adjusted for acute physiology and chronic health evaluation score II (APACHE II score) was used for mortality prediction.

Results: Twenty patients admitted with the diagnosis of severe sepsis and 10 patients with septic shock. The in-hospital mortality was 23.3% (7 patients). Admission BNP was significantly higher in the non-survivors 1123±236.08 versus 592.7±347.1 (P<0.001). By doing multivariate logestic regression, the predicatable variables for mortality was APACHE II score, BNP, and then EF.

Conclusion: BNP concentrations were increased in patients with severe sepsis or septic shock and poor outcome was associated with high BNP levels; thus, it may serve as a useful laboratory marker to predict survival in these patients.