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Prognostic merit of N‐terminal‐proBNP and N‐terminal‐proANP in mechanically ventilated critically ill patients
Author(s) -
BERDAL J.E.,
STAVEM K.,
OMLAND T.,
HALL C.,
SMITHERICHSSEN N.
Publication year - 2008
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2008.01737.x
Subject(s) - medicine , critically ill , terminal (telecommunication) , mechanical ventilation , intensive care medicine , telecommunications , computer science
Background: Amino‐terminal fragments of type‐A and type‐B natriuretic peptide prohormones (NT‐proBNP, NT‐proANP) are powerful prognostic markers in patients with cardiac disease, and NT‐proBNP has been demonstrated to predict outcome in severe sepsis and septic shock. We assessed the prognostic value of NT‐proBNP and NT‐proANP in a consecutive series of mechanically ventilated intensive care patients and compared their prognostic merit. Methods: Seventy unselected patients admitted to the intensive care unit (ICU) were included in the study 48 h after start of controlled mechanical ventilation. Venous blood was obtained on inclusion and assayed for NT‐proBNP and NT‐pro ANP. Univariate and multivariate logistic regression analysis was used to assess the association of NT‐proBNP and NT‐proANP levels with 30‐day mortality. Established risk factors and possible confounders were used as covariates. Discrimination of different prognostic models was assessed calculating the area under the receiver‐operating characteristics curve (ROC‐AUC). Results: NT‐proBNP and NT‐proANP levels were higher in non‐survivors ( n =25) than in 30‐day survivors ( n =45). Log NT‐proBNP [odds ratio (OR) 2.34, 95% CI 1.17–4.66], and log NT‐proANP (OR 2.44, 95% CI 1.12–5.30) were independently predictive of increased mortality. A prior diagnosis of chronic obstructive lung disease was predictive of decreased mortality (OR 0.29, 95% CI 0.08–1.00). The relative prognostic values, evaluated by the ROC‐AUCs of NT‐proBNP (AUC 0.74, 95% CI 0.61–0.86) and NT‐proANP (AUC 0.73, 95% CI 0.61–0.86), were nearly identical. Conclusions: High NT‐proANP and NT‐proBNP levels associated with decreased short‐term survival in unselected, mechanically ventilated ICU patients. NT‐proANP performed equally well as a prognostic indicator as NT‐proBNP, and may represent a clinically useful alternative to NT‐proBNP.