N-terminal pro-brain natriuretic peptide and high-sensitivity troponin T exhibit additive prognostic value for the outcome of critically ill patients

Background: Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. Methods: We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter. Results: Of the included 148 patients, 52% were male, mean age was of 64.2 ± 16.8 years and 30-day mortality was 33.2%. Non-survivors showed significantly higher NT-proBNP and TnT plasma levels as compared with survivors ( p<0.01). An elevation of both markers exhibited an additive effect on mortality, as those with both NT-proBNP and TnT levels above the median had a 30-day mortality rate of 51.0%, while those with both markers below the median had a 16.7% mortality rate (hazard ratio 3.7). These findings were independent of demographic and clinical parameters ( p<0.05). Conclusions: Our findings regarding the individual predictive properties of NT-proBNP and TnT are in line with literature. However, we were able to highlight that they exhibit additive prognostic potential which exceeds their individual value. This might be attributed to a difference in underlying pathomechanisms and an assessment of synergistic risk factors.

Download Full-text

N-terminal Pro-brain Natriuretic Peptide plasma levels are Associated With a Short-Term Diagnosis of Cancer in Patients with Coronary Artery Disease

10.21203/rs.3.rs-135088/v1 ◽

2020 ◽

Author(s):

José Tuñón ◽

Álvaro Aceña ◽

Ana Pello ◽

Sergio Ramos-Cillán ◽

Juan Martínez-Milla ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Plasma Levels ◽

High Sensitivity ◽

Short Term ◽

Artery Disease

Abstract Background N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the short term. Methods We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. Results After 5.40 (2.81-6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015-1.056) per increase in 100 pg/ml; p=0.001], previous atrial fibrillation [HR 3.140 CI (1.196-8.243); p=0.020], and absence of previous heart failure [HR 0.067 CI (0.006-0.802); p=0.033] were independent predictors of a receiving a CD in first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. A previous history of heart failure was present in 3.3% of patients receiving a CD in the first three years of follow-up, in 0.0% of those receiving this diagnosis beyond three years, and in 12.3% of patients not developing cancer (p=0.036). Conclusions In patients with coronary artery disease, NT-proBNP is an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers. The existence of previous heart failure does not account for these differences. New studies in large populations are needed to confirm these findings.

Download Full-text

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide and High-Sensitivity Troponin T Levels in the Natural History of Transthyretin Amyloid Cardiomyopathy and Their Evolution after Tafamidis Treatment

Journal of Clinical Medicine ◽

10.3390/jcm10214868 ◽

2021 ◽

Vol 10 (21) ◽

pp. 4868

Author(s):

Silvia Oghina ◽

Constant Josse ◽

Mélanie Bézard ◽

Mounira Kharoubi ◽

Marc-Antoine Delbarre ◽

...

Keyword(s):

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Prognostic Value ◽

Troponin T ◽

High Sensitivity ◽

Relative Increase ◽

High Sensitivity Troponin ◽

Increased Risk ◽

Amyloid Cardiomyopathy ◽

High Sensitivity Troponin T

Background: We assesse the evolution and prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (cTnT-HS) in transthyretin amyloid cardiomyopathy (ATTR-CA) before and after tafamidis treatment. Methods and Results: 454 ATTR-CA patients without tafamidis (Cohort A) and 248 ATTR-CA with tafamidis (Cohort B) were enrolled. Event-free survival (EFS) events were death, heart transplant, or acute heart failure. In Cohort A, 27% of patients maintained NT-proBNP < 3000 ng/L and 14% cTnT-HS < 50 ng/L at 12 months relative to baseline levels. In Cohort B, the proportions were 49% and 29%, respectively. In Cohort A, among the 333 patients without an increased NT-proBNP > 50% relative to baseline EFS was extended compared to the 121 patients with an increased NT-proBNP > 50% (HR: 0.75 [0.57; 0.98]; p = 0.032). In Cohort A, baseline NT-proBNP > 3000 ng/L and cTnT-HS > 50 ng/L and a relative increase of NT-proBNP > 50% during follow-up were independent prognostic factors of EFS. The slopes of logs NT-proBNP and cTnT-HS increased with time before and stabilized after tafamidis. Conclusion: ATTR-CA patients with increasing NT-proBNP had an increased risk of EFS. Tafamidis stabilize NT-proBNP and cTnT-HS increasing, even if initial NT-proBNP levels were >3000 ng/L. Thus suggesting that all patients, irrespective of baseline NT-proBNP levels, may benefit from tafamidis.

Download Full-text

Plasma levels of high-energy compounds compared with severity of illness in critically ill patients in the intensive care unit

Surgery ◽

10.1016/s0039-6060(98)70076-5 ◽

1998 ◽

Vol 124 (1) ◽

pp. 65-72 ◽

Cited By ~ 20

Author(s):

Clarence M. Jabs ◽

Gisli H. Sigurdsson ◽

Peter Neglen

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Plasma Levels ◽

Severity Of Illness ◽

High Energy

Download Full-text

Plasma Level of N Terminal Pro-Brain Natriuretic Peptide as a Prognostic Marker in Critically Ill Patients

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)70252-1 ◽

2007 ◽

Vol 2007 ◽

pp. 55-56

Author(s):

C.E. Bekes

Keyword(s):

Plasma Level ◽

Brain Natriuretic Peptide ◽

Critically Ill ◽

Natriuretic Peptide ◽

Prognostic Marker ◽

Critically Ill Patients

Download Full-text

Growth differentiation factor 15, ST2, high-sensitivity troponin T, and N-terminal pro brain natriuretic peptide in heart failure with preserved vs. reduced ejection fraction

European Journal of Heart Failure ◽

10.1093/eurjhf/hfs130 ◽

2012 ◽

Vol 14 (12) ◽

pp. 1338-1347 ◽

Cited By ~ 115

Author(s):

Rajalakshmi Santhanakrishnan ◽

Jenny P.C. Chong ◽

Tze P. Ng ◽

Lieng H. Ling ◽

David Sim ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Troponin T ◽

High Sensitivity ◽

Growth Differentiation Factor 15 ◽

Reduced Ejection Fraction ◽

Differentiation Factor ◽

High Sensitivity Troponin T

Download Full-text

Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909112437028 ◽

2012 ◽

Vol 30 (1) ◽

pp. 7-11 ◽

Cited By ~ 4

Author(s):

Silvio A. Ñamendys-Silva ◽

María O. González-Herrera ◽

Julia Texcocano-Becerra ◽

Angel Herrera-Gómez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Factors ◽

Mortality Rate ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Gynecological Cancer ◽

Apache Ii ◽

Apache Ii Score

Purpose: To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis. Methods: Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. Results: Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048). Conclusions: The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.

Download Full-text

Brain Natriuretic Peptide to Predict Successful Liberation from Mechanical Ventilation in Critically Ill Patients: a Systematic Review and Meta-Analysis

10.21203/rs.2.19088/v2 ◽

2020 ◽

Author(s):

Jean Deschamps ◽

Sarah K. Andersen ◽

Jordan Webber ◽

Robin Featherstone ◽

Meghan Sebastianski ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Brain Natriuretic Peptide ◽

Critically Ill ◽

Natriuretic Peptide ◽

Critically Ill Patients ◽

Meta Analysis ◽

Spontaneous Breathing Trial ◽

Clinical Criteria ◽

Alternate Test

Abstract Background: Predicting successful liberation from mechanical ventilation (MV) in critically ill patients is challenging. Brain natriuretic peptide (BNP) has been proposed to help guide decision-making for readiness to liberate from MV following a spontaneous breathing trial (SBT). Methods : We performed a systematic review and meta-analysis of randomized and prospective observational studies that measured BNP levels at the time of SBT in patients receiving MV. The primary endpoint was successful liberation from MV (absence of re-intubation or non-invasive ventilation at 48h). Statistical analyses included bi-variate and Moses-Littenberg models, and DerSimonian-Laird pooling of areas under ROC curve (AUROC). Results: A total of 731 articles were screened. Eighteen adult and 2 pediatric studies were fulfilled pre-specified eligibility. The measure of the relative variation of BNP during SBT (DBNP%) after exclusion of SBT failure by clinical criteria in adults yielded a sensitivity and specificity of 0.889 [0.831-0.929] and 0.828 [0.730-0.896] for successful liberation from MV respectively, with a pooled AUROC of 0.92 [0.88-0.97]. The pooled AUROC for any method of analysis for absolute variation of BNP (DBNP), pre-SBT BNP and post-SBT BNP were 0.89 [0.83-0.95], 0.77 [0.63-0.91], and 0.85 [0.80-0.90], respectively.Conclusion: The relative change in BNP during a SBT has potential value as an incremental tool after successful SBT to predict successful liberation from MV in adults. There is insufficient data to support the use of BNP in children or as an alternate test to clinical indices of SBT or the use of DBNP, BNP-pre and BNP-post as an alternate or incremental test.Trial registration number: PROSPERO CRD42018087474 (2018-02-06)

Download Full-text

Insulin therapy for hyperglycemia in critically ill patients

Paediatrica Indonesiana ◽

10.14238/pi53.5.2013.250-3 ◽

2016 ◽

Vol 53 (5) ◽

pp. 250

Author(s):

Julianti Julianti ◽

Silvia Triratna ◽

Aditiawati Aditiawati ◽

Irfanuddin Irfanuddin

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Mortality Rate ◽

Insulin Therapy ◽

Critically Ill ◽

Organ Dysfunction ◽

Critically Ill Patients ◽

Therapy Group ◽

Control Group

Background Hyperglycemia in critically ill patients is associated with higher mortality. Insulin therapy may improve outcomes, not only by preventing deleterious effects of hyperglycemia, but by improving the molecular dynamics in organ dysfunction.Objectives To assess the effects of insulin therapy on critically ill patients in an intensive care unit (ICU) setting and the risk of hypoglycemia.Methods An open-label, clinical trial was conducted in the Pediatric Intensive Care Unit (PICU) of Dr. Moh. Hoesin Hospital, Palembang, from November 2011 to March 2012. Subjects were consecutively assigned to receive either regular insulin at a dose of 0.05 U/kg/h if the blood glucose level reached >200 mg%, or standard therapy (control group). Blood glucose levels were measured hourly until they reached 80-110 mg%. Dose adjustments were made when the blood glucose level reached 145 mg%, by reducing the insulin dose to 0.025 U/kg/h. Outcomes of therapy were measured by Pediatric Logistic Organ Dysfunction (PELOD) score improvement, mortality rate and the occurrence of hypoglycemia.Results Forty subjects were enrolled in this study, with 20 subjects assigned to the insulin therapy group and 20 subjects to the standard therapy group. Two subjects, one from each group, were not included in the final analysis due to their deaths within 24 hours. There was no significant difference in distribution of PELOD scores before intervention between the groups (OR=0.5; 95%CI 0.1 to 1.9, P=0.32). However, after intervention, the PELOD scores was significantly lower in insulin therapy group compared to control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). In the insulin group after intervention, fewer subjects had scores >20.5 and more subjects had scores ≤20.5, indicated a lower risk of organ dysfunction. There was also a significantly lower mortality rate in the insulin group compared to the control group (OR 0.2; 95% CI 0.05 to 0.8, P=0.02). None of the subjects suffered hypoglycemia.Conclusion Insulin is beneficial in improving organ dysfunction and decreasing mortality for critically ill patients.

Download Full-text