Key result
Admission B-type natriuretic peptide levels ≥300 pg/mL were independently associated with long-term mortality in critically ill patients (OR 4.1; 95% CI 1.45-11.5; P=0.008).
Why the study?
Does admission B-type natriuretic peptide predict long-term mortality in mechanically-ventilated critically ill patients with non-cardiac primary diagnoses?
Cohort (n=103)
No
Does admission B-type natriuretic peptide predict long-term mortality in mechanically-ventilated critically ill patients with non-cardiac primary diagnoses?
Odds Ratio: 4.1 (95% CI 1.45–11.5)
p-value: p=0.008
In mechanically-ventilated ICU patients with non-cardiac diagnoses, elevated admission BNP (≥300 pg/mL) is a strong independent predictor of long-term mortality.
May inform long-term risk stratification in non-cardiac ventilated ICU patients; hypothesis-generating and should not yet change practice.
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 non-cardiac 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 B-type 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.
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Baptista et al. (2011) conducted a cohort in Critically ill patients with non-cardiac primary diagnosis (n=103). Admission B-type natriuretic peptide ≥300 pg/mL vs. Admission B-type natriuretic peptide <300 pg/mL was evaluated on Long-term mortality (OR 4.1, 95% CI 1.45-11.5, p=0.008). Admission B-type natriuretic peptide levels ≥300 pg/mL were independently associated with long-term mortality in critically ill patients (OR 4.1; 95% CI 1.45-11.5; P=0.008).
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