Therapeutic effects of recombinant human brain natriuretic peptide on cardiac function in patients with septic shock

Abstract

Objective To observe the change of cardiac function and tissue perfusion in septic shock patients treated with recombinant human brain natriuretic peptide (rhBNP) in a single center prospective randomized controlled study, and the therapeutic effects of it were analyzed . Methods A total of 100 patients with septic shock admitted in the ICU ward of Guangdong General Hospital were prospectively studied from January 2014 to February 2016. In reference to 6 h early goal-directed therapy (EGDT), 49 patients of experimental group treated with rhBNP and 51 patients of control group without rhBNP treatment were randomly generated by means of random number table. The main parameters of outcome were defined in cardiac index (CI) and amino terminal pro-BNP precursor (NT-proBNP) level in venous blood in patients 72 hours after presence or absence of the treatment of rhBNP, and the secondary parameters of outcome were confined to the patient's heart rate (HR), mean arterial pressure (MAP), transcutaneous oxygen saturation (SPO2), lactic acid (LAC) in patients 72 hours after presence or absence of the treatment of rhBNP. At the same time, the changes in the levels of NT-proBNP, Lac and HR, CI, MAP, SPO2 at 0 h, 24 h, 48 h, and 72 hours after treatment with rhBNP in the experimental group and control group without rhBNP treatment were recorded in order to detect the therapeutic effects of rhBNP. Results There were no significant differences in demographics between the two groups. Compared with control group, the length of ICU stay time was shorter[ (12.93±7.45) vs.( 20.67±6.96) , P<0.01] and the mortality rate was lower in the experimental group (30.6%, (15/49) vs.54.9%, (28/51), P=0.014). After treatment for 72 h, the level of Pro-BNP in experimental group was significantly lower than that in control group (14 965.7 ± 5 984.5)pg/mL vs.(17 392.5 ± 3 830.5)pg/mL, P=0.030); the CI in experimental group were significantly improved compared to control group [(4.0 ± 0.2)vs.(3.7 ± 0.6), P=0.002]. the Lac were significantly decreased in experimental group compared to control group [(2.4 ± 0.6)mmol/L vs.(3.7 ± 0.6)mmol / L, P=0.001]. The HR in experimental group were significantly decreased after treatment for 24 h compared to HR before the treatment with rhBNP (the HR in patients before treatment of rhBNP was (113.3 ± 7.2)beats/min, the HR in patients with the treatment of rhBNP for 24 h was (97.5 ± 14.7)beats/min; but there was no significant further change in HR during 24 h-72 h; there were no significant changes in MAP and SPO2 in patients before and after the treatment of rhBNP. Conclusions The rhBNP can significantly reduce Pro-BNP and lactate levels and improve cardiac index in septic shock patients treated with rhBNP for 24 h, suggesting that rhBNP can improve cardiac function and tissue perfusion in septic shock patients. Key words: Lyophilized recombinant human brain natriuretic peptide; Septic shock; Cardiac function; NT-proBNP; Heart rate; Mean arterial pressure; Transcutaneous oxygen saturation; Lactic acid