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BNP concentrations were increased in patients with severe sepsis or septic shock and poor outcome was associated with high BNP levels; thus, it may serve as a useful laboratory marker to predict survival in these patients.
The concentrations of BNP were increased in patients with severe sepsis or septic shock regardless of the presence or absence of cardiac dysfunction. Neither the BNP levels for the first 3 days nor the daily changes in BNP provided prognostic value for in-hospital mortality and length of stay in this mixed group of patients, which included patients with chronic cardiac dysfunction.[2] However, in another study, the authors concluded that plasma BNP level is a valuable prognostic factor for severe sepsis and septic shock patients.[3]
Myocardial depression is well recognized as an early feature of human septic shock, causing absence of appropriate oxygen supply to the peripheral tissues and subsequent death. Early systolic dysfunction has been identified in these patients and it seems to be inversely related to mortality.[4,5]
BNP is a relatively inexpensive and simple test, which is now widely available in clinical practice. BNP is also a predictor of both echocardiographic parameters of ventricular dysfunction as well as clinical outcomes in patients with acute and chronic heart disease. BNP has also been hypothesized to be a marker for ventricular dysfunction in patients infected with human immunodeficiency virus.[6,7]
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Elevated BNP levels (>100 pg/mL) were seen in 42% and 69% of patients on presentation and at 24 hours, respectively. Elevated BNP ranges (>230 pg/mL) were significantly associated with myocardial dysfunction and severity of global tissue hypoxia. When adjusted for age, gender, history of heart failure, renal function, organ dysfunction, and mean arterial pressure, a BNP greater than 210 pg/mL at 24 hours was the most significant independent indicator of increased mortality: odds ratio 1.061 (1.026-1.097), P < .001, 95% confidence interval. Patients with severe sepsis and septic shock often have elevated BNP levels, which are significantly associated with organ and myocardial dysfunction, global tissue hypoxia, and mortality. Serial BNP levels may be a useful adjunct in the early detection, stratification, treatment, and prognostication of high-risk patients.
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