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CRITICAL CARE AND TRAUMA

Plasma Level of N Terminal Pro-Brain Natriuretic Peptide as a Prognostic Marker in Critically Ill Patients

Yaniv Almog, MD^*, Victor Novack, MD, Rinat Megralishvili, RN,CCRN^*, Sergio Kobal, MD, Leonid Barski, MD, Daniel King, MD, and Doron Zahger, MD

*Medical Intensive Care Unit and the Departments of Medicine and Cardiology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel

Address correspondence and reprint requests to Yaniv Almog, MD, Medical Intensive Care Unit, Soroka University Medical Center, P.O.B. 151, Beer-Sheva, 84101, Israel. Address e-mail to almogya{at}bgu.ac.il.

We studied whether N-terminal pro brain natriuretic peptide (NT-pro BNP) measured at intensive care unit admission is an independent predictor of mortality in critically ill patients. We conducted a prospective observational cohort study enrolling 78 patients with APACHE II scores more than 12. Serum NT-pro BNP and cardiac troponin T were measured at admission, and echocardiography was performed within 24 h. The primary end-point was 30-day mortality. The median NT-pro BNP levels of the 22 (28.2%) patients who died were significantly more frequent than that of those who survived (8328 versus 1016 pg/mL; P = 0.001). Patients with NT-pro BNP levels more than 1900 pg/mL had significantly more frequent mortality (47.2% versus 11.9%; P = 0.03). This group also had more frequent moderate to severe left ventricular dysfunction (30.6% versus 9.5%; P = 0.02) and abnormal cardiac troponin T levels (33.3% versus 14.3%; P = 0.05). Multivariate analyses adjusted for APACHE-II revealed that a NT-pro BNP level more than 1900 pg/mL is an independent predictor of mortality.

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