Prognostic value of plasma N-terminal probrain natriuretic peptide levels in the acute respiratory distress syndrome

Ednan K. Bajwa, James L. Januzzi, Michelle Ng Gong, B. Taylor Thompson, David C. Christiani

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

OBJECTIVE: Patients with acute respiratory distress syndrome suffer from profound cardiac and pulmonary derangement, including right ventricular strain and noncardiogenic pulmonary edema, which may potentially alter concentrations of cardiac natriuretic peptides. We sought to determine whether N-terminal probrain natriuretic peptide (NT-proBNP) levels are elevated in acute respiratory distress syndrome and whether they can serve as a marker of prognosis in this setting. DESIGN: Prospective study. SETTING: Tertiary-care academic medical center. PATIENTS: One hundred seventy-seven acute respiratory distress syndrome subjects enrolled in a prospective intensive care unit cohort. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: NT-proBNP was measured from blood taken within 48 hrs of acute respiratory distress syndrome onset. Patients were followed for the primary outcome of 60-day mortality and secondary outcomes of organ dysfunction and ventilator-free days. Seventy patients died (40%). Median NT-proBNP level was 3181 ng/L (interquartile range 723-9246 ng/L). NT-proBNP levels were significantly higher among nonsurvivors (p < .0001). Receiver operating curve analysis revealed an optimal NT-proBNP cut-point of 6813 ng/L for predicting death. Patients with levels above the cut-point had significantly higher odds of mortality on multivariable analysis (odds ratio 2.36, 95% confidence interval 1.11-4.99, p ≤ .02) than those with levels below the cut-point. Kaplan-Meier survival analysis showed that this difference emerged early and was sustained (p < .0001). Patients with elevated NT-proBNP also had higher organ dysfunction scores (p < .0001) and fewer ventilator free days (p ≤ .03) than those with lower NT-proBNP levels. CONCLUSIONS: NT-proBNP levels are elevated among acute respiratory distress syndrome patients and parallel the severity of the syndrome and likelihood for morbidity and mortality. This demonstrates the potential utility of this biomarker for prognosis in this disease.

Original languageEnglish (US)
Pages (from-to)2322-2327
Number of pages6
JournalCritical Care Medicine
Volume36
Issue number8
DOIs
StatePublished - Aug 2008
Externally publishedYes

Fingerprint

Natriuretic Peptides
Adult Respiratory Distress Syndrome
Mechanical Ventilators
Mortality
Organ Dysfunction Scores
Kaplan-Meier Estimate
Pulmonary Edema
Tertiary Healthcare
Survival Analysis
Intensive Care Units
Biomarkers
Odds Ratio
Prospective Studies
Confidence Intervals
Morbidity
Lung

Keywords

  • Acute respiratory distress syndrome
  • Biological markers
  • N-terminal pro-BNP
  • Prognosis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Prognostic value of plasma N-terminal probrain natriuretic peptide levels in the acute respiratory distress syndrome. / Bajwa, Ednan K.; Januzzi, James L.; Gong, Michelle Ng; Thompson, B. Taylor; Christiani, David C.

In: Critical Care Medicine, Vol. 36, No. 8, 08.2008, p. 2322-2327.

Research output: Contribution to journalArticle

Bajwa, Ednan K. ; Januzzi, James L. ; Gong, Michelle Ng ; Thompson, B. Taylor ; Christiani, David C. / Prognostic value of plasma N-terminal probrain natriuretic peptide levels in the acute respiratory distress syndrome. In: Critical Care Medicine. 2008 ; Vol. 36, No. 8. pp. 2322-2327.
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T1 - Prognostic value of plasma N-terminal probrain natriuretic peptide levels in the acute respiratory distress syndrome

AU - Bajwa, Ednan K.

AU - Januzzi, James L.

AU - Gong, Michelle Ng

AU - Thompson, B. Taylor

AU - Christiani, David C.

PY - 2008/8

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N2 - OBJECTIVE: Patients with acute respiratory distress syndrome suffer from profound cardiac and pulmonary derangement, including right ventricular strain and noncardiogenic pulmonary edema, which may potentially alter concentrations of cardiac natriuretic peptides. We sought to determine whether N-terminal probrain natriuretic peptide (NT-proBNP) levels are elevated in acute respiratory distress syndrome and whether they can serve as a marker of prognosis in this setting. DESIGN: Prospective study. SETTING: Tertiary-care academic medical center. PATIENTS: One hundred seventy-seven acute respiratory distress syndrome subjects enrolled in a prospective intensive care unit cohort. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: NT-proBNP was measured from blood taken within 48 hrs of acute respiratory distress syndrome onset. Patients were followed for the primary outcome of 60-day mortality and secondary outcomes of organ dysfunction and ventilator-free days. Seventy patients died (40%). Median NT-proBNP level was 3181 ng/L (interquartile range 723-9246 ng/L). NT-proBNP levels were significantly higher among nonsurvivors (p < .0001). Receiver operating curve analysis revealed an optimal NT-proBNP cut-point of 6813 ng/L for predicting death. Patients with levels above the cut-point had significantly higher odds of mortality on multivariable analysis (odds ratio 2.36, 95% confidence interval 1.11-4.99, p ≤ .02) than those with levels below the cut-point. Kaplan-Meier survival analysis showed that this difference emerged early and was sustained (p < .0001). Patients with elevated NT-proBNP also had higher organ dysfunction scores (p < .0001) and fewer ventilator free days (p ≤ .03) than those with lower NT-proBNP levels. CONCLUSIONS: NT-proBNP levels are elevated among acute respiratory distress syndrome patients and parallel the severity of the syndrome and likelihood for morbidity and mortality. This demonstrates the potential utility of this biomarker for prognosis in this disease.

AB - OBJECTIVE: Patients with acute respiratory distress syndrome suffer from profound cardiac and pulmonary derangement, including right ventricular strain and noncardiogenic pulmonary edema, which may potentially alter concentrations of cardiac natriuretic peptides. We sought to determine whether N-terminal probrain natriuretic peptide (NT-proBNP) levels are elevated in acute respiratory distress syndrome and whether they can serve as a marker of prognosis in this setting. DESIGN: Prospective study. SETTING: Tertiary-care academic medical center. PATIENTS: One hundred seventy-seven acute respiratory distress syndrome subjects enrolled in a prospective intensive care unit cohort. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: NT-proBNP was measured from blood taken within 48 hrs of acute respiratory distress syndrome onset. Patients were followed for the primary outcome of 60-day mortality and secondary outcomes of organ dysfunction and ventilator-free days. Seventy patients died (40%). Median NT-proBNP level was 3181 ng/L (interquartile range 723-9246 ng/L). NT-proBNP levels were significantly higher among nonsurvivors (p < .0001). Receiver operating curve analysis revealed an optimal NT-proBNP cut-point of 6813 ng/L for predicting death. Patients with levels above the cut-point had significantly higher odds of mortality on multivariable analysis (odds ratio 2.36, 95% confidence interval 1.11-4.99, p ≤ .02) than those with levels below the cut-point. Kaplan-Meier survival analysis showed that this difference emerged early and was sustained (p < .0001). Patients with elevated NT-proBNP also had higher organ dysfunction scores (p < .0001) and fewer ventilator free days (p ≤ .03) than those with lower NT-proBNP levels. CONCLUSIONS: NT-proBNP levels are elevated among acute respiratory distress syndrome patients and parallel the severity of the syndrome and likelihood for morbidity and mortality. This demonstrates the potential utility of this biomarker for prognosis in this disease.

KW - Acute respiratory distress syndrome

KW - Biological markers

KW - N-terminal pro-BNP

KW - Prognosis

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