engleski

Prognostic relavance of Pra-atrial natriuretic peptide in septic patients.

PROGNOSTIC RELEVANCE OF THE PRO-ATRIAL NATRIURETIC PEPTIDE IN SEPTIC PATIENTS Mazul- Sunko B(1), Bekavac-Beslin M(2), Vrkic N(3), Siranovic M(4), Zarkovic N(5)(1)Department of Anaesthesiology and Intensive Care, University Hospital Sestre Milosrdnice, (2)Department of Surgery, (3)Department of Clinical Chemistry, University Hospital Sestre milosrdnice, (4)Department of Anaesthesiology and Intensive Care, University Hospital Sestre Milosrdnice, (5)Department of Molecular Biology, Institute Rugjer Boskovic, Zagreb, Croatia INTRODUCTION. Pro-atrial natriuretic peptide, ProANP(1-98), is a well established prognostic marker in patients with myocardial infarction and chronic heart failure. However, its prognostic relevance among septic surgical patients is not clear. METHODS. 40 surgical patients with the diagnosis of sepsis, severe sepsis and septic shock were included in the study.Blood samples from the proximal part of the pulmonary artery catheter, where ProANP(1-98)is predominantly secernated, were drawn on admittance to the ICU. ProANP(-98)was determined using a commercial assay (Biomedica gmbh, Wiena). ProANP(1-98)plasma level was correlated with all standard biochemical parameters, haemodynamic variables and clinical scoring systems, APACHE II and MODS. RESULTS. ProANP(1-98) was significantly higher in nonsurvivors (6390± ; ; ; ; 7688 fmol/L) than in survivors (2811± ; ; ; ; 1926 fmol/L, p=0.03). It is also correlated with APACHE II (r=0.46, p=0.003) and MODS (r=0.57, p=0.001). The results of logistic regression show the highest prognostic value for ProANP(1-98)(ln)(p=0.03), MODS(p=0.03), platlets (p=0.03)and calculated creatinine clearence (p=0.05). ROC analysis shows that the cut-off value of 4700 fmol/L of ProANP(1-98) has sensitivity of 85 % and specificity of 45 %.The AUC in the model of the logistic regression which includes all four variables is 0, 89 which implies that the combination of the three standard prognostic markers and ProANP(1-98) has a high prognostic value. CONCLUSION. The results of the study show that ProANP(1-98)is correlated with the standard clinical scoring systems APACHE II and MODS in septic patients on admittance to the ICU.It joins the biochemical parameters which are well established prognostic markers, platlets and calculated creatinine clearence in the global logistic regression model with a high predictive value. The study imply that ProANP(1-98) could be a novel prognostic marker and an important mediator in sepsis, possibly through its haemodynamic effects or interaction with cytokine system (1). REFERENCE(S). 1.Witthaut R, et al.Int Care Med 2003 ; 29:1696-1702.

ProANP(1-98); sepsis; prognostic

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