0
Correspondence |

Plasma Levels of N-Terminal Pro-Brain Natriuretic Peptide in the Critically Ill: The Right Hormonal Marker in the Wrong Patients? FREE TO VIEW

Matthias Heringlake, MD; Ludger Bahlmann, MD; Stephan Klaus, MD
Author and Funding Information

Affiliations: Klinik für Anästhesiologie, Universität zu Lübeck, Lübeck, Germany,  St. John Hospital and Medical Center, Detroit, MI

Correspondence to: Matthias Heringlake, MD, Klinik für Anästhesiologie, Universität zu Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany; e-mail: Heringlake@t-online.de



Chest. 2006;129(1):212-213. doi:10.1378/chest.129.1.212-a
Text Size: A A A
Published online

To the Editor:

A recent article by Jefic and coworkers1(July 2005) on the utility of N-terminal pro-brain natriuretic peptide (NTproBNP) for estimation of pulmonary artery occlusion pressure (PAOP) in critically ill patients concluded that NTproBNP may be a strong discriminator of cardiac dysfunction in these patients. The authors observed inverse correlations between NTproBNP and cardiac index and left ventricular stroke work index (LVSWI) but not between NTproBNP and PAOP. This suggests that, in contrast to patients with heart failure,2 other factors than the physiologic stimulus ventricular stretch may be involved: the accompanying disease process (sepsis,3surgery4) and pharmacologic factors.

We have shown that 15 mL/kg of NaCl 0.9% IV induces a 250% increase in NTproBNP levels in volunteers.5 The patients of Jefic et al1 will have been treated with a much higher volume/sodium load and, additionally, many drugs that have not been studied yet regarding effects on NTproBNP. Thus, the correlations between NTproBNP, cardiac index, and LVSWI may be an epiphenomonen of underlying disease and therapy, and increased NTproBNP levels in these patients should better be interpreted as signs of multiorgan dysfunction instead of cardiac dysfunction.

Dr. Heringlake has received and continues to receive support by Roche Diagnostics, Germany (manufacturer of NTproBNP kits and analyzers), in the form of analytical materials and costs for external analyses.

Jefic, D, Lee, JW, Savoy-Moore, RT, et al (2005) Utility of B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide in evaluation of respiratory failure in critically ill patients.Chest128,288-295
 
Kazanegra, R, Cheng, V, Garcia, A, et al A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study.J Card Fail2001;7,21-29
 
Brueckmann, M, Huhle, G, Lang, S, et al Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis.Circulation2005;112,527-534
 
Berendes, E, Van Aken, H, Raufhake, C, et al Differential secretion of atrial and brain natriuretic peptide in critically ill patients.Anesth Analg2001;93,676-682
 
Heringlake, M, Heide, C, Bahlmann, L, et al Effects of tilting and volume loading on plasma levels and urinary excretion of relaxin, NT-pro-ANP, and NT-pro-BNP in male volunteers.J Appl Physiol2004;97,173-179
 
To the Editor:

We appreciate the comments of Dr. Heringlake and colleagues. In our study, we initially asked whether levels of brain natriuretic peptide (BNP) and N-terminal (NT)-proBNP could help us to discern cardiac from noncardiac causes of pulmonary infiltrates in ICU patients requiring hemodynamic monitoring. We recognized that levels of natriuretic peptides were markedly elevated in many of these critically ill patients with multiorgan failure. Heringlake et al showed that NT-proBNP could become elevated by infusion of saline even in normal volunteers.

The strong correlation that we observed between NT-proBNP and left ventricular stroke work index suggests that natriuretic peptides may prove to be markers of impaired contractility in this patient population. We suspect that in critically ill patients the levels of natriuretic peptides are elevated and that cardiac contractility is diminished due to the deleterious effects of multiorgan failure on the neurohormonal pathways affecting the cardiorenal axis.


Figures

Tables

References

Jefic, D, Lee, JW, Savoy-Moore, RT, et al (2005) Utility of B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide in evaluation of respiratory failure in critically ill patients.Chest128,288-295
 
Kazanegra, R, Cheng, V, Garcia, A, et al A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study.J Card Fail2001;7,21-29
 
Brueckmann, M, Huhle, G, Lang, S, et al Prognostic value of plasma N-terminal pro-brain natriuretic peptide in patients with severe sepsis.Circulation2005;112,527-534
 
Berendes, E, Van Aken, H, Raufhake, C, et al Differential secretion of atrial and brain natriuretic peptide in critically ill patients.Anesth Analg2001;93,676-682
 
Heringlake, M, Heide, C, Bahlmann, L, et al Effects of tilting and volume loading on plasma levels and urinary excretion of relaxin, NT-pro-ANP, and NT-pro-BNP in male volunteers.J Appl Physiol2004;97,173-179
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543