What does this research mean for the field?

In critically ill patients, both ANP and BNP concentrations are elevated compared to healthy controls, but neither serves as a predictor for illness severity or mortality, and only ANP correlates with parameters of water and electrolyte balance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 1, 2001

Differential Secretion of Atrial and Brain Natriuretic Peptide in Critically Ill Patients

Structured PICO

Do ANP and BNP levels correlate with water/electrolyte balance, severity of illness, or mortality in critically ill patients?

Population

178 critically ill patients

Intervention

Measurement of plasma Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)

Comparator

Healthy controls

Outcome

Plasma concentrations of ANP and BNP, and their correlation with aldosterone, sodium, osmolality, central venous pressure, severity of illness, and mortalitysurrogate

In critically ill patients, ANP and BNP are elevated but do not predict severity of illness or mortality, though ANP correlates with markers of water and electrolyte balance.

Abstract

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are cardiac hormones with natriuretic, vasorelaxant, and aldosterone-inhibiting properties. We analyzed the plasma of 178 critically ill patients for ANP, BNP, aldosterone, and serum sodium concentration, as well as serum and urine osmolality and sodium filtration fraction. Mean plasma concentrations of ANP and BNP were increased in critically ill patients compared with healthy controls (ANP, 14.3 +/- 5.8 pmol/L versus 8.8 +/- 3.2 pmol/L, P < 0.05; BNP, 26.2 +/- 10.7 pmol/L versus 4.6 +/- 2.8 pmol/L, P < 0.0001). The relative increases in ANP concentrations were comparable in all diseases. BNP concentrations, by contrast, showed a wider variation. The largest BNP concentrations were observed in patients who underwent cardiac surgical procedures and in patients with subarachnoid hemorrhage. ANP, but not BNP, was correlated with aldosterone levels (r = 0.4, P < 0.001), serum sodium (r = 0.42, P < 0.001), sodium filtration fraction (r = 0.3, P < 0.001), serum osmolality (r = 0.25, P < 0.01), urinary osmolality (r = -0.24, P < 0.01), and central venous pressure (r = 0.22, P < 0.01). ANP and BNP concentrations were increased in critically ill patients; however, this did not correlate with the severity of illness or mortality. Our data support a regulatory role for ANP in the maintenance of water and electrolyte balance. The physiologic role of BNP, by contrast, is less clear. ANP and BNP are not predictors for the severity of illness and mortality in critically ill patients.

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