Abstract
Brain natriuretic peptide (BNP) is a neurohormone released in response to volume expansion and increased pressure. It is commonly used to assist in the diagnosis and management of heart failure. BNP can also play an important role as a biomarker in septic shock; however, elevations of BNP in conditions other than sepsis or cardiac dysfunction limits its use as the sole prognostic marker in patients hospitalized with sepsis. Further relationships regarding laboratory value and correlation with severity of illness need to be established with larger prospective studies to develop consensus regarding a cut-off point for optimum sensitivity and specificity in predicting in-hospital mortality related to sepsis.
Highlights
BackgroundNatriuretic peptides are peptide hormones mostly released by the heart muscles in response to increased volume status and wall stress, which are key elements in cardiovascular physiology [1]
Brain natriuretic peptide (BNP) is a commonly measured natriuretic peptide, which is released in conditions that leads to volume expansion and increased myocardial wall pressure
Larger prospective studies are required to establish further relationships regarding laboratory value and correlation with the severity of the illness to better identify a cut-off point for optimum sensitivity and specificity in predicting in-hospital mortality related to sepsis
Summary
Natriuretic peptides are peptide hormones mostly released by the heart muscles in response to increased volume status and wall stress, which are key elements in cardiovascular physiology [1]. Sepsis is an inflammatory response to an infection characterized by systemic inflammation and lifethreatening organ dysfunction [10] It is a major cause of hospitalization and critical care admissions and is associated with a significant healthcare burden globally. Khoury et al concluded that admission plasma BNP above 1,000 pg/ml independently predicted short- and long-term mortality in hospitalized patients with sepsis and septic shock [23]. Cuthbertson et al showed elevated BNP levels in patients with sepsis and septic shock, but failed to show any predictive value in terms of mortality or outcome after intensive care [26]. Vallabhajosyula et al analyzed 35 studies (3,508 patients) and concluded that a cut-off level of plasma BNP of 633 pg/ml shows the greatest discrimination for mortality with an area under the receiver operating characteristic (ROC) curve of 0.766 (95% CI: 0.734-0.797) [16]. As the authors have pointed out, the heterogeneity of the included patient population means that these results are not applicable to all the patients admitted with sepsis and septic shock
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