The roles of using B-type natriuretic peptide to predict the severity of community-acquired pneumonia / 中华急诊医学杂志

Objective To evaluate the roles of B-type natriuretic peptide (BNP) in predicting the severity of community-acquired pneumonia (CAP) by studying the correlation between them.Methods A total of 202 patients with CAP admitted from December 2011 to December 2012 were enrolled in this study.All these patients were checked with laboratory tests for BNP level,C-reactive protein (CRP),white blood cell count (WBC) as well as other markers needed for obtaining pneumonia severity index (PSI).The differences in BNP levels,CRP levels,and WBC were compared among different degrees of pneumonia severity,and the correlation between BNP levels and PSI was investigated by a linear correlation analysis.The patients enrolled were divided into a high-risk group (defined as Ⅳ-Ⅴ grade of PSI) and a low-risk group (defined as Ⅰ-Ⅲgrade of PSI).Meanwhile,they were also divided into a survivor group and a non-survivor group according to outcomes.BNP levels between the two groups were compared,and a receiver operating characteristic (ROC) curve analysis was performed on the BNP levels versus PSI.Results BNP levels increased with CAP severity (r =0.782,P ＜0.01).The mean level of BNP (263.2 ± 119.6) pg/mLof patients in the high-risk group was significantly higher than that of patients (71.5 ± 54.3) pg/mL in the low-risk group (P ＜ 0.01).The patients in the non-survivor group had significantly higher BNP levels compared to the survivor group [(343.86 ± 125.49) vs.(183.00 ±121.71) pg/mL,P ＜ 0.01].In addition,there were positive correlations between BNP levels and PSI (r =0.782,P＜0.001),between BNP levels and CRP levels (r =0.560,P＜0.01),and between BNP levels and WBC (r =0.513,P＜0.001).The BNP level had a high accuracy in predicting the severity of CAP (AUC =0.952).The optimal cut-off point of BNP level for distinguishing high-risk from low-risk patients was 125.0 pg/mL,with a semitivity of 0.891 and a specificity of 0.946.Moreover,BNP level had a definite accuracy in predicting mortality (AUC =0.823).Its optimal cut-off point for predicting death was 299.0 pg/mL,with a sensitivity of 0.675 and a specificity of 0.816; its negative predictive cut-off value was 0.926,and positive predictive value was 0.426.Conclusions BNP level is positively correlated with the severity of CAP.The patient with BNP level above 125.0 pg/mL should be hospitalized immediately and patients with BNP level higher than 299.0 pg/mL are at the high risk of death.Therefore,BNP is a useful biomarker for evaluating the severity of patients with CAP.

Curative effects of Levocarnitine on chronic congestive heart failure / 中国基层医药

Objective To discuss influence and curative effects of Levocarnitine on serum B-type natriuretic peptide (BNP) and β-endorphin levels of old patients with chronic congestive heart failure (CHF).Methods 86 patients with CHF were divided into the observation group and control group by random number table.The patients in the two groups were given routine anti-heart failure treatment,such as bed rest,oxygen uptake,low sodium diet,strong heart diuresis,dilation of blood vessels and etc.The patients in the observation group were additionally given 2.0g Levocarnitine by intravenous infusion once a day for 14 days.The changes of serum BNP and β-endorphin levels of patients in the two groups before and 14 days after medical treatment were observed,and clinical curative effect and untoward effect were compared as well.Results After 14 days medical treatment,the serum BNP and β-endorphin levels of patients in the two groups[(345.85 ±58.25)pg/mL,(120.84 ±25.13)pg/mL,(237.04 ±60.54)pg/mL, (92.08 ±26.17) pg/mL] obviously declined than before (405.28 ±83.07) pg/mL,(146.42 ±30.72) pg/mL, (410.23 ±75.12)pg/mL,(150.56 ±32.51)pg/mL](t=2.24,2.31,3.18,2.96,P0.05). Conclusion Levocarnitine is a kind of adjunctive therapy ( AT) drug to treat CHF,whose mechanism of action has close effect on reducing serum BNP andβ-endorphin levels and adjusting neuroendocrine hormone levels.

Relationship between Plasma Thyrotropin and Brain Natriuretic Peptide in Elderly Patients with Diastolic Heart Failure / 中国康复理论与实践

@#ObjectiveTo investigate the relationship between thyrotropin (TSH) levels and B-type natriuretic peptide (BNP) in elderly patients with diastolic heart failure (DHF). MethodsPlasma levels of TSH and BNP were measured in 93 elderly patients diagnosed DHF clinically. ResultsThe BNP was (1011.07±238.27) pg/ml and (769.36±169.55) pg/ml in patients with high TSH level（>5.5 μIU/ml, n=46) and normal TSH level (0.35～5.5 μIU/ml, n=47) (P<0.05), respectively. ConclusionHigh TSH levels might promote the plasma BNP secretion in elderly patients with diastolic heart failure.

Prediction of B-type Natriuretic Peptide for Cardiac Events after Noncardiac Surgery in Aged Patients / 中国康复理论与实践

@# Objective To explore the value of B-type natriuretic peptide (BNP) predicting cardiac events after noncardiac surgery in the aged patients. Methods The level of BNP， the score of Goldman analysis and the cardiac risk grade of ACC/AHA guideline were analyzed in 274 aged patients for cardiac outcome after noncardiac surgery. Results Preoperative BNP concentration>100 pg/ml，score of Goldman≥13，and the high or moderate risk grade by ACC/AHA guideline were related with cardiac events. There was no significant difference in the index such as sensitivity，specificity, accuracy，positive predictive value and negative predictive value for cardiac events between BNP level and cardiac risk grade. Compared with the score of Goldman, BNP was more sensitive （100% vs 55.6%）and negatively predictive （100% vs 96.3%） for cardiac events. Conclusion The risk of cardiac events after noncardiac surgery could be predicted with the level of BNP before operation in the aged patient.

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

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.

B-type Natriuretic Peptide as a Predictor of Cardiovascular Disease in End-Stage Renal Disease Patients Commencing Hemodialysis / 대한신장학회잡지

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in end- stage renal disease (ESRD) patients. The early diagnosis and treatment of CVD could improve survival in dialysis patients. The plasma level of B-type Natriuretic Peptide (BNP) correlates with the severity of LV dysfunction and increases following myocardial ischemia. We investigated the ability of BNP as a predictor of CVD in new ESRD patients whose volume overload status were not corrected. METHODS: CVD was defined as an LV ejection fraction <45% or a positive myocardial SPECT. We measured plasma levels of BNP in 79 new ESRD patients requiring hemodialysis (HD) and investigated the relationships between BNP levels and echocardiography and myocardial SPECT. RESULTS: Median concentrations of BNP were higher in 16 patients with heart failure than those in 63 patients without heart failure (1, 748.5 vs. 127.0 pg/mL, p<0.001) and higher in 12 patients with positive myocardial SPECT than those in 67 patients with negative SPECT (1, 160.5 vs. 129.0 pg/mL, p< 0.001). BNP levels were higher in 23 patients with CVD than those in 56 patients without CVD (1, 234.0 vs. 119.0 pg/mL, p<0.001). There was an inverse correlation between BNP and LV ejection fraction (r=-0.65, p<0.001). The present study demonstrated a significant 34.9% increment of cardiac mortality by the every increase of 100 pg/mL of BNP. The negative predictive value of BNP for excluding CVD was 89.3% (cut-off value, 500 pg/mL). CONCLUSION: Our findings suggest that BNP could be an effective screening test for the evaluation of the presence of CVD in ESRD patients starting maintenance HD.

Clinical benefits of serum BNP measurement in patients with chronic kidney disease / 대한내과학회지

BACKGROUND: B-type natriuretic peptide (BNP) regulates excretion of water and sodium in the kidney, and serum levels of BNP are increased in the settings of decreased ventricular contractility and myocardial overload. Serum levels of BNP and renal function are important prognostic factors in congestive heart failure, and when renal function deteriorates, BNP level is increased. This study aimed to assess the clinical benefits of BNP measurement in patients with chronic kidney disease (CKD) for prediction of congestive heart failure (CHF). METHODS: Serum levels of BNP were measured in 75 patients with CKD who admitted to Soonchunhyang university Bucheon hospital between the period of April 2003 and April 2004. The clinical data, laboratory findings and echocardiographic findings in these patients were compared retrospectively. RESULTS: The average BNP level of the 75 patients was 1,645.3+/-1,830.9 pg/mL. There were no differences in BNP levels between K/DOQI CKD stages. Levels of BNP were higher in CKD patients with heart failure compared to those without heart failure. BNP levels showed a negative correlation to left ventricular ejection fraction and significant elevation in patients with pulmonary congestion and weight gain on admission. There was no difference in BNP levels in patients with or without left vetricular hypertrophy, and diabetes mellitus. The best cutoff level of BNP for evaluation of heart failure in patients with CKD was 500 pg/mL, with a sensitivity of 78%, specificity of 53%, positive predictive value of 34%, and negative predictive value of 88%, respectively. CONCLUSION: BNP levels showed no difference with the degree of renal failure in patients with CKD, and levels were increased with heart failure in patients with CKD. We discovered though, that in patients with CKD the measurement of serum BNP is a useful factor in assessment of coexisting heart failure, volume status and ischemic heart disease.

B-type Natriuretic Peptide Value for Diagnosis of Congestive Heart Failure in Patients with decreased Renal Function

PURPOSE: A number of studies have examined the B-type natriuretic peptide level in dialysis patients and in patients with lesser degrees of renal insufficiency. However, relationships between BNP and renal function are unknown. We sought to assess the diagnostic utility of BNP in differentiating congestive heart failure (CHF) from non-congestive heart failure (non-CHF) in patients with renal insufficiency. METHODS: BNP levels were obtained in 395 patients presenting to our emergency department with dyspnea. Of those 395 patients, 48 patients showed renal insufficiency. Patients transferred to other hospitals and those in a donot- resuscitate state were excluded. RESULTS: In patients with acute renal failure, patients with CHF (n=8) had BNP levels of 360+/-254 pg/ml whereas patients with non-CHF (n=3) had BNP levels of 114+/-103 pg/ml; however, this difference was not statistically significant. In patients with chronic renal failure, patients with CHF (n=22) had BNP levels of 1147+/-635 pg/ml, which was significantly higher than the BNP levels of 459+/-508 pg/ml for patients with non-CHF (n=7) (p=0.01). The area under the receiver operating curve, which plots sensitivity versus specificity for BNP levels in separating congestive heart failure from non-congestive heart failure in patients with chronic renal failure, was 0.805 (p=0.01). The diagnostic accuracy of BNP at a cutoff of 600 pg/ml was 76 %. CONCLUSION: The BNP cut-off value for diagnosis of CHF in patients with chronic renal failure is 600 pg/ml.

Utility of B-Type Natriuretic Peptide in Detecting Left Ventricular Systolic Dysfunction

BACKGROUND: B-type natriuretic peptide (BNP), a neurohormone released from the cardiac ventricles, is widely accepted as a diagnostic marker of congestive heart failure. Relationship between BNP and left ventricular systolic dysfunction (LVSD) remains inconclusive. METHODS: Echocardiogram and BNP (Triage(R), pg/ml) were obtained in 332 patients who were admitted in the division of Cardiology of St. Mary's Hospital. Mean and median BNP values, capacity of BNP to differentiate LVSD were assessed using student's t test and receiver-operating-characteristic (ROC) curves. RESULTS: LVSD and dyspnea independently elevated both mean and median values of BNP. BNP had a fair capacity to differentiate mild LVSD or left ventricular ejection fraction (LVEF) or =35% (area under the ROC curve 0.90) at cutoff value of 180 pg/ml. In patients without LVSD but BNP level greater than 100 pg/ml, tachyarrhythmia, valvular heart disease, myocardial infarction, left ventricular hypertrophy, pulmonary artery hypertension were frequent findings. CONCLUSIONS: BNP is an excellent test in differentiating moderate to severe LVSD or LVEF < or =35 in patients having cardiac diseases or seeking urgent medical care, and in selecting out candidates for echocardiogram.

B-type Natriuretic Peptide in Differentiating Acute Dyspnea

PURPOSE: This study was to test the diagnostic value of Btype natriuretic peptide (BNP) for differentiating between the causes of acute dyspnea. METHODS: We conducted a prospective study of 41 patients who came to the emergency department with acute dyspnea between August 1, 2002, and October 31, 2002. Plasma BNP was measured for a bedside assay. We excluded patients who suffered from dyspnea due to airway obstruction, hyperventilation syndrome, psychiatric causes, drug intoxication, and chronic renal failure or from dyspnea of neuromuscular origin. The clinical diagnosis of congestive heart failure was adjudicated by echocardiographic findings. Two emergency physicians, who were blinded to the results of the BNP assay and the echocardiographic findings, determined the cause of dyspnea as regard to the Framingham criteria. RESULTS: The final diagnosis of dyspnea was due to a cardiogenic origin in 29 patients (71%), and due to a noncardiogenic origin in 12 patients (29%). The plasma BNP levels in themselves were more specific and sensitive in diagnosing cardiogenic dyspnea than was a clinical decision based on the authority of the Framingham criteria. In the echocardiographic findings, the left-ventricular end-systolic dimension and the left- ventricular end-diastolic dimension were positively correlated with the plasma BNP levels(R=0.44, p=0.002 and R=0.40, p=0.005), the ejection fraction was negatively correlated (R=-0.46, p=0.001). In the multiple logistic-regression analysis, measurements of the plasma BNP level added significant independent predictive power to other clinical variables in the models. CONCLUSION: The assay of plasma BNP in the emergency department was useful method for differentiating acute dyspnea based on its cause, and the plasma BNP level was corresponded to the degree of left ventricular dysfunction.

The Usefulness of B-type Natriuretic Peptide test in Critically Ill, Noncardiac Patients / 결핵

BACKGROUND: Previous studies have suggested that a B-type natriuretic peptide(BNP) test can provide important information on diagnosis, as well as predicting the severity and prognosis of heart failure. Myocardial dysfunction is often observed in critically ill noncardiac patients admitted to the Intensive Care Unit, and the prognosis of the myocardial dysfunction needs to be determined. This study evaluated the predictability of BNP on the prognosis of critically ill noncardiac patients. METHODS: 32 ICU patients, who were hospitalized from June to October 2002 and in whom the BNP test was evaluated, were enrolled in this study. The exclusion criteria included the conditions that could increase the BNP levels irrespective of the severity, such as congestive heart failure, atrial fibrillation, ischemic heart disease, and renal insufficiencies. A triage B-Type Natriuretic Peptide test with a RIA-kit was used for the fluorescence immunoassay of BNP test. In addition, the acute physiology and the chronic health evaluation (APACHE)IIscore and mortality were recorded. RESULTS: There were 16 males and 16 females enrolled in this study. The mean age was 59 years old. The mean BNP levels between the ICU patients and control were significantly different (186.7+/-274.1pg/mL vs. 19.9+/-21.3 pg/mL, p=0.033). Among the ICU patients, there were 14(44%) patients with BNPlevels above 100 pg/mL. The APACHEIIscore was 16.5+/-7.6. In addition, there were 11 mortalities reported. The correlation between the BNP and APACHEIIscore, between the BNP and mortality were significant (r=0.443, p=0.011 & r=0.530, p=0.002). The mean BNP levels between the dead and alive groups were significantly different (384.1+/-401.7 pg/mL vs. 83.2+/-55.8 pg/mL p=0.033). However, the PaO2/FiO2 did not significantly correlate with the BNP level. CONCLUSION: This study evaluated the BNP level was elevated in critically ill, noncardiac patients. The BNP level could be a useful, noninvasive tool for predicting the prognosis of the critically ill, noncardiac patients.