Increased B-type natriuretic peptide and decreased proteinuria might reflect decreased capillary leakage and is associated with a better outcome in patients with severe burns

Autor: W.M.T. Janssen, Anuschka S. Niemeijer, Karina de Leeuw, G.I.J.M. Beerthuizen, Hans Eshuis, Marianne K. Nieuwenhuis
Přispěvatelé: Functional recovery and quality of life after burns
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Male
Resuscitation
vrouwelijk
Critical Care and Intensive Care Medicine
proteïnurie
Natriuretic Peptide
Brain
Outcome Assessment
Health Care
Natriuretic peptide
gezondheidszorg
Prospective Studies
Prospective cohort study
bloed
Netherlands
Proteinuria
Trauma Severity Indices
Capillary Leak Syndrome/physiopathology
Middle Aged
Water-Electrolyte Balance
Cardiology
cardiovascular system
Nederland
Female
middelbare leeftijd
medicine.symptom
Burns
hormones
hormone substitutes
and hormone antagonists
circulatory and respiratory physiology
Adult
medicine.medical_specialty
medicine.drug_class
brain
Renal function
retrospectieve studies
blood
hersenen
Internal medicine
mensen
biologische markers
medicine
Humans
In patient
cardiovascular diseases
outcome assessment
volwassene
Retrospective Studies
brandwonden
health care methods
water-electrolyt balans
business.industry
Research
Retrospective cohort study
mannelijk
Surgery
Fluid Therapy
business
natriuretic peptides
vloeistof therapie
human activities
Biomarkers
Capillary Leak Syndrome
Zdroj: Critical Care
Critical care, 15(4):R161. Springer Science + Business Media
ISSN: 1466-609X
1364-8535
Popis: INTRODUCTION: It is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate to systemic capillary leakage. This study investigates whether combining BNP and proteinuria can be used as a guide for individualized resuscitation and as a predictor of outcome in patients with severe burns. METHODS: From 2006 to 2009, 38 consecutive patients (age 47 ± 15 years, 74% male) with severe burns were included and followed for 20 days. All had normal kidney function at admission. BNP and proteinuria were routinely measured. Ordered and actually administered fluid resuscitation volumes were recorded. The Sequential Organ Failure Assessment (SOFA) score was used as the measure of outcome. RESULTS: BNP increased during follow-up, reaching a plateau level at Day 3. Based on median BNP levels at Day 3, patients were divided into those with low BNP and those with high BNP levels. Both groups had comparable initial SOFA scores. Patients with high BNP received less fluid from Days 3 to 10. Furthermore, patients with a high BNP at Day 3 had less morbidity, reflected by lower SOFA scores on the following days. To minimize effects of biological variability, proteinuria on Days 1 and 2 was averaged. By dividing the patients based on median BNP at Day 3 and median proteinuria, patients with high BNP and low proteinuria had significantly lower SOFA scores during the entire follow-up period compared to those patients with low BNP and high proteinuria. CONCLUSIONS: Patients with higher BNP levels received less fluid. This might be explained by a lower capillary leakage in these patients, resulting in more intravascular fluid and consequently an increase in BNP. In combination with low proteinuria, possibly reflecting minimal systemic capillary leakage, a high BNP level was associated with a better outcome. BNP and proteinuria have prognostic potential in severely burned patients and may be used to adjust individual resuscitation.
Databáze: OpenAIRE
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