Abstract
We investigated whether N-terminal proB-type natriuretic peptide (NT-proBNP) predicts the prognosis of patients with acute respiratory distress syndrome (ARDS). Between December 1, 2012, and May 31, 2015, this observational study recruited patients admitted to our tertiary medical center who met the Berlin criteria for ARDS and who had their NT-proBNP measured. The main outcome was 28-day mortality. We enrolled 61 patients who met the Berlin criteria for ARDS: 7 were classified as mild, 29 as moderate, and 25 as severe. The median APACHE II scores were 23 (interquartile range [IQR], 18–28), and SOFA scores were 11 (IQR, 8–13). The median lung injury score was 3.0 (IQR, 2.50–3.25), and the median level of NT-proBNP was 2011 pg/ml (IQR, 579–7216). Thirty-four patients died during this study, and the 28-day mortality rate was 55.7%. Patients who die were older and had significantly (all p < 0.05) higher APACHE II scores and NT-proBNP levels than did patients who survived. Multivariate analysis identified age (HR: 1.546, 95% CI: 1.174–2.035, p = 0.0019) and NT-proBNP (HR: 1.009, 95% CI: 1.004–1.013, p = 0.0001) as significant risk factors of death. NT-proBNP was associated with poor outcomes for patients with ARDS, and its level predicted mortality.
Highlights
Acute respiratory distress syndrome (ARDS) can develop as a consequence of various direct pulmonary insults, e.g., infectious pneumonia, aspiration, traumatic lung contusion, or of indirect lung injuries, e.g., sepsis, shock, massive blood transfusion, and non-pulmonary trauma[1]
We investigated whether the level of NT-proBNP is a precise predictor of the prognosis in patients with acute respiratory distress syndrome (ARDS)
The intensive care unit (ICU) team makes rounds at least once daily, and respiratory therapists are responsible for managing all mechanical ventilation (MV), including weaning and spontaneous breathing trials (SBT)
Summary
Acute respiratory distress syndrome (ARDS) can develop as a consequence of various direct pulmonary insults, e.g., infectious pneumonia, aspiration, traumatic lung contusion, or of indirect lung injuries, e.g., sepsis, shock, massive blood transfusion, and non-pulmonary trauma[1]. The Berlin criteria better predictors of mortality in patients with ARDS than is the AECC definition, the absolute value of the area under the receiver-operating curve (ROC) for predicting risk of death was only 0.5777. All of these findings should indicate that the initial hypoxemic level is not an optimal predictor for an outcome prognosis in patients with ARDS, and that we need other significant prognostic factors for predicting the outcomes. NT-proBNP are diagnostic tools for assessing fluid status and cardiac strain in congestive heart failure, pulmonary hypertension, and other cardiovascular diseases In addition to their diagnostic usefulness, BNP and NT-proBNP can provide strong prognostic information of an unfavorable outcome in patients with heart failure[10,11].
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