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Original Research: Critical Care |

B-Type Natriuretic Peptide, Aldosterone, and Fluid Management in ARDS

Matthew W. Semler, MD; Annis M. Marney, MD; Todd W. Rice, MD; Hui Nian, MS; Chang Yu, PhD; Arthur P. Wheeler, MD; Nancy J. Brown, MD
Author and Funding Information

Drs Semler and Marney contributed equally to this manuscript.

FUNDING/SUPPORT: The original trial on which these analyses were based was supported by the National Heart, Lung, and Blood Institute (NHLBI) and the National Institutes of Health (NIH) [NO1-HR-46046-64 and NO1-HR-16146-54]. Investigators conducting the current study were supported by an NHLBI T32 award [HL087738 09] and the NIH [R01HL060906]. Biomarker assays were funded by the Vanderbilt Institute for Clinical and Translational Research [UL1 TR000445 from National Center for Advancing Translational Sciences/NIH].

aDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN

bDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN

cDepartment of Medicine, Vanderbilt University Medical Center, Nashville, TN

dFrist Clinic, Endocrinology, Nashville, TN

CORRESPONDENCE TO: Matthew W. Semler, MD, 1161 21st Ave S, T-2220 MCN, Nashville, TN 37232-2650


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(1):102-111. doi:10.1016/j.chest.2016.03.017
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Background  Conservative fluid management increases ventilator-free days without influencing overall mortality in acute respiratory distress syndrome. Plasma concentrations of B-type natriuretic peptide (a marker of ventricular filling) or aldosterone (a marker of effective circulating volume) may identify patients for whom fluid management impacts survival.

Methods  This was a retrospective analysis of the Fluid and Catheter Treatment Trial (FACTT), a randomized trial comparing conservative with liberal fluid management in acute respiratory distress syndrome. Using plasma collected at study enrollment, we measured B-type natriuretic peptide and aldosterone by immunoassay. Multivariable analyses examined the interaction between B-type natriuretic peptide or aldosterone concentration and fluid strategy with regard to 60-day in-hospital mortality.

Results  Among 625 patients with adequate plasma, median B-type natriuretic peptide concentration was 825 pg/mL (interquartile range, 144-1,574 pg/mL), and median aldosterone was 2.49 ng/dL (interquartile range, 1.1-4.3 ng/dL). B-type natriuretic peptide did not predict overall mortality, correlate with fluid balance, or modify the effect of conservative vs liberal fluid management on outcomes. In contrast, among patients with lower aldosterone concentrations, conservative fluid management increased ventilator-free days (17.1 ± 9.8 vs 12.5 ± 10.3, P < .001) and decreased mortality (19% vs 30%, P = .03) (P value for interaction = .01).

Conclusions  In acute respiratory distress syndrome, B-type natriuretic peptide does not modify the effect of fluid management on outcomes. Lower initial aldosterone appears to identify patients for whom conservative fluid management may improve mortality.

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