Tuberc Respir Dis.  2007 May;62(5):389-397.

Utility of B-type Natriuretic Peptide in Patients with Acute Respiratory Distress Syndrome

Affiliations
  • 1Divison of Respiratory & Critical Care Medicine, Department of Internal Medicine, Kangnam St. Mary's Hospital, The Catholic University of Korea, Korea. youngkim@catholic.ac.kr
  • 2Divison of Cardiology Medicine, Department of Internal Medicine, Kangnam St. Mary's Hospital, Seoul, Korea.

Abstract

BACKGROUND: B-type natriuretic peptide (BNP) has been shown to be strong mortality predictors in a wide variety of cardiovascular syndromes. Little is known about BNP in patients with acute respiratory distress syndrome (ARDS). We studied whether BNP can predict mortality in patients with ARDS. METHOD: Echocardiographic study was done to all patients with ARDS, and we excluded patient with low ejection fraction (less than 50%) or showing any features of diastolic dysfunction. 47 patients were enrolled between December, 2003 and February, 2006. Parameters including BNP were obtained within 24h hours at the time of enrollment. RESULT: Mean BNP concentrations and APACHE II scores differed between the survivors and nonsurvivors (BNP, 219.5 +/- 57.7 pg/mL vs 492.3 +/- 88.8 pg/mL; p=0.013, APACHE II score, 17.4 +/- 1.6 vs 23.1 +/- 1.3, p=0.009, respectively). With the use of the threshold value for BNP of 585 pg/mL, the specificity for the prediction of mortality was 94%. The threshold value for APACHE II of 15.5 showed sensitivity of 87%. 'APACHE II + 11xlogBNP' showed sensitivity 63%, and specificity 82%, using threshold value for 46.14.
CONCLUSION
BNP concentrations and APCHE II scores were more elevated in nonsurvivors than survivors in patients with ARDS who have normal ejection fraction. BNP can predict mortality. Further study should be done.

Keyword

Acute Respiratory Distress Syndrome (ARDS); B-type natriuretic peptide (BNP); Mortality; Prognosis

MeSH Terms

APACHE
Echocardiography
Humans
Mortality
Natriuretic Peptide, Brain*
Prognosis
Respiratory Distress Syndrome, Adult*
Survivors
Natriuretic Peptide, Brain

Figure

  • Figure 1 Box and whiskers plots of median B-type natriuretic peptide (BNP) concentrations among surviving patients vs. those dying during the study. The median BNP concentrations among those dying were significantly higher than those surviving (p = 0.013).

  • Figure 2 Box and whiskers plots of median acute physiology and chronic health evaluation (APACHE) II scores among surviving patients vs. those dying during the study. The median APACHE II scores among those dying were significantly higher than those surviving (p = 0.009).

  • Figure 3 Receiver operating characteristic curve for BNP (left) APACHE II score (right) for the prediction of mortality. BNP: B-type natriuretic peptide; APACHE: Acute Physiology and Chronic Health Evaluation

  • Figure 4 Receiver operating characteristic curve for 'APACHE II score + 11×log BNP' for the prediction of mortality. BNP: B-type natriuretic peptide; APACHE: Acute Physiology and Chronic Health Evaluation


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