N-terminal-pro-BNP in critically ill patients with acute respiratory failure: a prospective cohort study

• Published in: Acta anaesthesiologica Scandinavica Vol. 55; no. 6; pp. 749 - 757
• Main Authors: OKKONEN, M., VARPULA, M., LINKO, R., PERTTILÄ, J., VARPULA, T., PETTILÄ, V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-07-2011; Blackwell
• Subjects: Acute Disease; Adult; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; Critical Illness; Female; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Prospective Studies; Respiratory Insufficiency - blood; Respiratory Insufficiency - mortality; Human; Anesthesia; Acute respiratory insufficiency; Critically ill; Cohort study
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2011.02439.x

Background: The aim of this study was to evaluate the prognostic value of plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP) in unselected critically ill patients with acute respiratory failure (ARF).
Methods: Prospective, observational cohort study in 25 intensive care units in Finland. This study included a total of 602 patients with laboratory samples from 958 consecutive patients with ARF treated either with invasive or with non‐invasive ventilatory support (the FINNALI study). Plasma NT‐pro‐BNP samples were drawn after the onset of ventilatory support (day 0) and on the morning of the second day.
Results: The median [interquartile ranges (IQR)] NT‐pro‐BNP‐values were significantly higher at baseline in 90‐day non‐survivors than the survivors, 4378 pg/ml (1400–13,943 pg/ml) vs. 1052 pg/ml (232–4076 pg/ml), respectively. The median (IQR) NT‐pro‐BNP values were significantly higher in patients with chronic cardiac disease or cardiac surgery than in non‐cardiac patients, 1947 pg/ml (801–4687 pg/ml) vs. 417 pg/ml (153–1735 pg/ml), respectively, if renal function was normal. With deteriorating renal function, the NT‐pro‐BNP values showed a significant increase. The area under curve for baseline NT‐pro‐BNP predicting 90‐day mortality was moderate: 0.718 (95% confidence interval 0.674–0.761). Baseline NT‐pro‐BNP over 1765 pg/ml was independently associated with 90‐day mortality by logistic regression analysis (P<0.001).
Conclusions: NT‐pro‐BNP on admission is commonly elevated and independently associated with 90‐day mortality in critically ill ARF patients. However, the routine use of NT‐pro‐BNP for prognostic purpose does not seem to add value to clinical data in ARF patients.