- 期刊
N-terminal Pro-brain Natriuretic Peptide as a Prognostic Predictor in Critical Care Patients with Acute Cardiogenic Pulmonary Edema
NT-proBNP為重症加護病人急性心因性肺水腫之預後預測因子
摘要
Background: This study evaluated plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) as a potential prognostic predictor in critical care patients with acute cardiogenic pulmonary edema within 24 hours after admission. Methods: Fifty patients with acute cardiogenic pulmonary edema admitted to our intensive care unit (ICU) were enrolled. They were divided into two groups: a nonsystolic heart failure (NS-CHF) group with preserved left ventricular ejection fraction (LVEF≥50%, n = 24) and a systolic heart failure (S-CHF) group with reduced LVEF (＜ 50%, n = 26). Plasma NT-proBNP levels and LVEF by bedside echocardiography were measured within 24 hours of admission. Combined adverse cardiac events (death or heart failure) and all-cause mortality were monitored. Results: The levels of plasma NT-proBNP in NS-CHF and S-CHF groups were 6055.7 ± 5039.5 pg/mL and 20343.8 ± 11968.4 pg/mL, respectively (p＜0.001). Patients with lower body mass index (BMI), anemia, and impaired renal function were more frequently found in the high plasma NT-proBNP group (NT-proBNP levels ≥9215 pg/mL). During the follow-up period, the group of patients with higher plasma NT-proBNP levels (≥ 9215 pg/mL) had more adverse cardiac events (hazard ratio 4.967, p = 0.011) and a higher mortality rate (hazard ratio 58.94, p = 0.004). The plasma NT-proBNP level was the only significant independent predictor of combined adverse cardiac events and all-cause mortality. The use of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker (ACEI/ARB) and beta-blocker was also associated with a lower hazard ratio of all-cause mortality (0.030 and 0.064 respectively, p=0.002 and 0.046). Conclusions: In critical care patients with acute cardiogenic pulmonary edema, plasma NT-proBNP level within 24 hours after admission is an independent predictor of combined adverse cardiac events and all-cause mortality. The use of ACEI/ARB and beta-blocker also predicts a lower rate of all-cause mortality in these patients.
並列摘要
Background: This study evaluated plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) as a potential prognostic predictor in critical care patients with acute cardiogenic pulmonary edema within 24 hours after admission. Methods: Fifty patients with acute cardiogenic pulmonary edema admitted to our intensive care unit (ICU) were enrolled. They were divided into two groups: a nonsystolic heart failure (NS-CHF) group with preserved left ventricular ejection fraction (LVEF≥50%, n = 24) and a systolic heart failure (S-CHF) group with reduced LVEF (＜ 50%, n = 26). Plasma NT-proBNP levels and LVEF by bedside echocardiography were measured within 24 hours of admission. Combined adverse cardiac events (death or heart failure) and all-cause mortality were monitored. Results: The levels of plasma NT-proBNP in NS-CHF and S-CHF groups were 6055.7 ± 5039.5 pg/mL and 20343.8 ± 11968.4 pg/mL, respectively (p＜0.001). Patients with lower body mass index (BMI), anemia, and impaired renal function were more frequently found in the high plasma NT-proBNP group (NT-proBNP levels ≥9215 pg/mL). During the follow-up period, the group of patients with higher plasma NT-proBNP levels (≥ 9215 pg/mL) had more adverse cardiac events (hazard ratio 4.967, p = 0.011) and a higher mortality rate (hazard ratio 58.94, p = 0.004). The plasma NT-proBNP level was the only significant independent predictor of combined adverse cardiac events and all-cause mortality. The use of angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker (ACEI/ARB) and beta-blocker was also associated with a lower hazard ratio of all-cause mortality (0.030 and 0.064 respectively, p=0.002 and 0.046). Conclusions: In critical care patients with acute cardiogenic pulmonary edema, plasma NT-proBNP level within 24 hours after admission is an independent predictor of combined adverse cardiac events and all-cause mortality. The use of ACEI/ARB and beta-blocker also predicts a lower rate of all-cause mortality in these patients.