RESUMO
OBJECTIVES: C-type natriuretic peptide (CNP), a member of the natriuretic peptide family, is produced in vascular endothelium. We assessed the accuracy of natriuretic (NT)-proCNP, the N-terminal fragment of the C-type natriuretic peptide precursor, in predicting development of sepsis in multiple-traumatized patients with/without traumatic brain injury verified by computed tomography. DESIGN: Retrospective clinical study. SETTING: Level II trauma center. PATIENTS: Three patient groups were stratified according to computed tomography results: isolated traumatic brain injury (n = 20), multiple-traumatized with traumatic brain injury (n = 26) and multiple-traumatized without traumatic brain injury (n = 26). During 13 days after multiple trauma, 37 (51%) patients developed sepsis. MEASUREMENTS AND MAIN RESULTS: Circulating plasma NT-proCNP levels were measured daily (days 0-13) in all patients. Without any retrospective stratification of trauma patients, plasma NT-proNCP levels did not differ in septic (n = 37) and nonseptic (n = 35) patients (p = .505). Between days 2 and 6 posttrauma, there was a significant (p = .002) increase of circulating NT-proCNP in multiple-traumatized patients without traumatic brain injury who developed sepsis (n = 19) compared with nonseptic multiple-traumatized patients without traumatic brain injury. Conversely, in septic patients either with traumatic brain injury alone or with multiple trauma and traumatic brain injury, the NT-proCNP showed a trend toward lower levels than in nonseptic patients. Prediction of sepsis (receiver-operating characteristic test) from days 2 to 6 after multiple trauma by NT-proCNP in patients without traumatic brain injury was accurate with an area under the curve of 0.84 +/- 0.03. The optimal cutoff value of 2.3 pmol/L produced sensitivity of 84% to 96% and specificity of 61% to 91% from day 2 to 6 after trauma. CONCLUSIONS: Our data showed that the levels of circulating NT-proCNP between multiple-traumatized patients without traumatic brain injury who do and do not develop sepsis are distinctly different. Plasma NT-proCNP concentration can potentially serve as an accurate predictor of sepsis in this cohort of patients.
Assuntos
Lesões Encefálicas/sangue , Lesões Encefálicas/mortalidade , Traumatismo Múltiplo/sangue , Traumatismo Múltiplo/mortalidade , Peptídeo Natriurético Tipo C/sangue , Sepse/diagnóstico , APACHE , Adulto , Análise de Variância , Áustria , Biomarcadores/sangue , Lesões Encefálicas/terapia , Estudos de Coortes , Cuidados Críticos/métodos , Feminino , Seguimentos , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/terapia , Distribuição Normal , Valor Preditivo dos Testes , Probabilidade , Estudos Retrospectivos , Medição de Risco , Sepse/sangue , Sepse/mortalidade , Taxa de Sobrevida , Centros de Traumatologia , Adulto JovemAssuntos
Mães , Peptídeos Natriuréticos/sangue , Gêmeos/sangue , Adulto , Feminino , Humanos , Recém-NascidoRESUMO
This paper describes a method for the direct measurement of human sRANKL (receptor activator of NF-kappaB ligand), a cytokine of the tumor necrosis factor superfamily, which is a key player in bone metabolism. Its role in the regulation of osteogenic disorders such as osteoporosis, Paget's disease and rheumatoid arthritis is being extensively discussed in the literature at present. We developed a highly specific, simple and reliable ELISA which allows the direct measurement of uncomplexed sRANKL in human serum. Assay characteristics such as analytical precision, sensitivity, interfering factors, sample stability and dilution linearity are shown. Reference values from healthy volunteers (n=57) were found to be between 0 and 2.7 pmol/l (10th-90th percentile) with a mean serum value of 1.3 pmol/l (median 0.9 pmol/l).
