Severe septic inflammation as a strong stimulus of myocardial NT-pro brain natriuretic peptide release

被引:14
作者
Wolff, Birger
Haase, Detlef
Lazarus, Peter
Machill, Klaus
Graf, Bernhard
Lestin, Heiko-Gundmar
Werner, Dierk
机构
[1] HELIOS Kliniken Schwerin, Dept Internal Med, Intens Care Div, D-19049 Schwerin, Germany
[2] HELIOS Kliniken, Inst Clin Chem & Lab Med, Schwerin, Germany
[3] HELIOS Kliniken, Dept Internal Med, Div Cardiol, Schwerin, Germany
关键词
NT-proBNP; septic shock; intensive care; acute coronary syndrome;
D O I
10.1016/j.ijcard.2006.11.051
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Septic shock ( SS) has recently been identified as stimulus of N-terminal pro-brain natriuretic peptide (NT-proBNP) release. We tested whether SS mediates NT-proBNP release through cardiomyocyte necrosis. Moreover, the discriminative value of NT-proBNP for the distinction between SS and non-septic shock (NSS) was assessed. Methods: The study included 50 ICU patients with SS (n=25) and NSS (n=25), 40 patients with acute coronary syndrome and elevated troponin-I (ACStrop+) and 16 patients with unstable angina and normal troponin- I (UAtrop-). Eleven subjects without inflammation or cardiac disease served as controls. NT-proBNP levels of coronary patients were measured on admission, those of ICU patients 48 h after onset of shock symptoms. Results: ACStrop+ ( 1525 [25th-75th percentile: 790-3820] pg/L) and NSS ( 687 [254-1552]) patients showed increased NT-proBNP levels above those of UAtrop- patients (107 [43-450], p<0.001) and controls (52 [42-99], p<0.001), but SS patients exhibited still higher levels (11,335 [4716-25,769], p<0.001 vs all others). Among ICU patients with shock symptoms, NT-proBNP discriminated SS and NSS with high sensitivity and specifity (area under ROC curve: 0.946 [95% confidence interval, 0.872-1.019]). NT-proBNP correlated with troponin-I, as marker of cardiomyocyte damage, among ACStrop+ (p<0.001) and SS patients (p=0.013). But, whereas SS patients showed the greatest NT-proBNP values, ACStrop+ patients had higher troponin-I levels (p<0.001), suggesting different mechanisms by which myocardial ischemia and SS mediate NT-proBNP release. Conclusions: SS is a more potent stimulus of NT-proBNP release than myocardial ischemia. NT-proBNP reliably distinguishes SS from other forms of shock. SS-related NT-proBNP release appears to involve cardiomyocyte damage but not genuine cardiomyocyte necrosis. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:131 / 136
页数:6
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