Top

Published in:

01-05-2008 | Original

Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure

Authors: Aurélie Lefebvre, Suzanne Kural-Menasché, Michael Darmon, Guillaume Thiéry, Jean-Paul Feugeas, Benoît Schlemmer, Élie Azoulay

Published in: Intensive Care Medicine | Issue 5/2008

Abstract

Objective

To assess the accuracy of plasma N-terminal-pro-B-type natriuretic peptide concentrations (NT-proBNP) as a diagnostic tool to recognize acute respiratory failure (ARF) of cardiac origin.

Methods

Prospective observational study in 100 medical intensive care unit (ICU) patients. NT-proBNP was measured at ICU admission, and diagnosis of cardiac dysfunction was performed using echocardiography.

Results

Sixteen patients had cardiac ARF, 58 patients had noncardiac ARF, and 26 patients were non-ARF controls. Median (IQR) NT-proBNP was 1,951 (617–9,320) pg/ml and was significantly influenced by the level of renal dysfunction. Patients with noncardiac ARF had higher NT-proBNP [1,912 (704–1,922) pg/ml] than non-ARF patients [1,022 (383–2,613) pg/ml], but lower concentrations than cardiac ARF patients [4,536 (1,568–35,171) pg/ml]. The area under the curve (AUC) was 0.663 ± 0.078 (95% confidence interval 0.510–0.815) and was not significantly influenced by the level of renal dysfunction. In addition, using a stepwise logistic regression model, NT-proBNP failed to predict independently the presence of cardiac dysfunction. However, with specificity and negative predictive value of 100%, a NT-proBNP cutoff value of 500 pg/ml seemed useful to rule out cardiac dysfunction. Indeed, none of the 16 patients with cardiac ARF had a NT-proBNP value below 500 pg/ml, whereas it was the case in 8 (30.8%) non-ARF controls and in 12 (20.7%) noncardiac ARF patients.

Conclusions

In cancer patients with ARF, plasma NT-proBNP concentration is not a relevant tool to recognize cardiac dysfunction, but is specific enough to rule out the diagnosis in patients with plasma NT-proBNP concentrations below 500 pg/ml.

Azoulay E, Schlemmer B (2006) Diagnostic strategy in cancer patients with acute respiratory failure. Intensive Care Med 32:808–822PubMedCrossRef

Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961PubMed

Soares M, Salluh JI, Spector N, Rocco JR (2005) Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for > 24 hrs. Crit Care Med 33:520–526PubMedCrossRef

Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328PubMedCrossRef

Azoulay E, Thiery G, Chevret S, Moreau D, Darmon M, Bergeron A, Yang K, Meignin V, Ciroldi M, Le Gall JR, Tazi A, Schlemmer B (2004) The prognosis of acute respiratory failure in critically ill cancer patients. Medicine (Baltimore) 83:360–370CrossRef

Chaoui D, Legrand O, Roche N, Cornet M, Lefebvre A, Peffault de Latour R, Sanhes L, Huchon G, Marie JP, Rabbat A (2004) Incidence and prognostic value of respiratory events in acute leukemia. Leukemia 18:670–675PubMedCrossRef

Groeger JS, White P, Jr., Nierman DM, Glassman J, Shi W, Horak D, Price K (1999) Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 17:991–997PubMed

Hilbert G, Gruson D, Vargas F, Valentino R, Favier JC, Portel L, Gbikpi-Benissan G, Cardinaud JP (2001) Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients. Crit Care Med 29:249–255PubMedCrossRef

Gruson D, Hilbert G, Portel L, Boiron JM, Bebear CM, Vargas F, Bebear C, Reiffers J, Gbikpi-Benissan G, Cardinaud JP (1999) Severe respiratory failure requiring ICU admission in bone marrow transplant recipients. Eur Respir J 13:883–887PubMedCrossRef

10.

Shorr AF, Susla GM, O'Grady NP (2004) Pulmonary infiltrates in the non-HIV-infected immunocompromised patient: etiologies, diagnostic strategies, and outcomes. Chest 125:260–271PubMedCrossRef

11.

Stover DE, Zaman MB, Hajdu SI, Lange M, Gold J, Armstrong D (1984) Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med 101:1–7PubMed

12.

Steg PG, Joubin L, McCord J, Abraham WT, Hollander JE, Omland T, Mentre F, McCullough PA, Maisel AS (2005) B-type natriuretic peptide and echocardiographic determination of ejection fraction in the diagnosis of congestive heart failure in patients with acute dyspnea. Chest 128:21–29PubMedCrossRef

13.

Mukoyama M, Nakao K, Hosoda K, Suga S, Saito Y, Ogawa Y, Shirakami G, Jougasaki M, Obata K, Yasue H, et al. (1991) Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide. J Clin Invest 87:1402–1412PubMedCrossRef

14.

Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167PubMedCrossRef

15.

Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L, Clopton P, Alberto J, Hlavin P, Maisel AS (2001) Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 37:379–385PubMedCrossRef

16.

McLean AS, Huang SJ, Nalos M, Tang B, Stewart DE (2003) The confounding effects of age, gender, serum creatinine, and electrolyte concentrations on plasma B-type natriuretic peptide concentrations in critically ill patients. Crit Care Med 31:2611–2618PubMedCrossRef

17.

Rana R, Vlahakis NE, Daniels CE, Jaffe AS, Klee GG, Hubmayr RD, Gajic O (2006) B-type natriuretic peptide in the assessment of acute lung injury and cardiogenic pulmonary edema. Crit Care Med 34:1941–1946PubMedCrossRef

18.

Rudiger A, Gasser S, Fischler M, Hornemann T, von Eckardstein A, Maggiorini M (2006) Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit Care Med 34:2140–2144PubMedCrossRef

19.

Bahlis NJ, Lazarus HM (2006) Multiple myeloma-associated AL amyloidosis: is a distinctive therapeutic approach warranted? Bone Marrow Transplant 38:7–15PubMedCrossRef

20.

Meinardi MT, van Veldhuisen DJ, Gietema JA, Dolsma WV, Boomsma F, van den Berg MP, Volkers C, Haaksma J, de Vries EG, Sleijfer DT, van der Graaf WT (2001) Prospective evaluation of early cardiac damage induced by epirubicin-containing adjuvant chemotherapy and locoregional radiotherapy in breast cancer patients. J Clin Oncol 19:2746–2753PubMed

21.

Snowden JA, Hill GR, Hunt P, Carnoutsos S, Spearing RL, Espiner E, Hart DN (2000) Assessment of cardiotoxicity during haemopoietic stem cell transplantation with plasma brain natriuretic peptide. Bone Marrow Transplant 26:309–313PubMedCrossRef

22.

Burjonroppa SC, Tong AT, Xiao LC, Johnson MM, Yusuf SW, Lenihan DJ (2007) Cancer patients with markedly elevated B-type natriuretic peptide may not have volume overload. Am J Clin Oncol 30:287–293PubMedCrossRef

23.

Forfia PR, Watkins SP, Rame JE, Stewart KJ, Shapiro EP (2005) Relationship between B-type natriuretic peptides and pulmonary capillary wedge pressure in the intensive care unit. J Am Coll Cardiol 45:1667–1671PubMedCrossRef

24.

Shor R, Rozenman Y, Bolshinsky A, Harpaz D, Tilis Y, Matas Z, Fux A, Boaz M, Halabe A (2006) BNP in septic patients without systolic myocardial dysfunction. Eur J Intern Med 17:536–540PubMedCrossRef

25.

Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810PubMedCrossRef

26.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

27.

Gandhi SK, Powers JC, Nomeir AM, Fowle K, Kitzman DW, Rankin KM, Little WC (2001) The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med 344:17–22PubMedCrossRef

28.

Brenner H (2002) Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 360:1131–1135PubMedCrossRef

29.

Kia M, Cooley A, Rimmer G, MacDonald T, Barber K, Manion P, Shapiro B, Socey J, Iddings D (2006) The efficacy of B-type natriuretic peptide for early identification of blood loss in traumatic injury. Am J Surg 191:353–357PubMedCrossRef

30.

Witthaut R, Busch C, Fraunberger P, Walli A, Seidel D, Pilz G, Stuttmann R, Speichermann N, Verner L, Werdan K (2003) Plasma atrial natriuretic peptide and brain natriuretic peptide are increased in septic shock: impact of interleukin-6 and sepsis-associated left ventricular dysfunction. Intensive Care Med 29:1696–1702PubMedCrossRef

31.

Jefic D, Lee JW, Savoy-Moore RT, Rosman HS (2005) Utility of B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide in evaluation of respiratory failure in critically ill patients. Chest 128:288–295PubMedCrossRef

32.

Daugaard G, Lassen U, Bie P, Pedersen EB, Jensen KT, Abildgaard U, Hesse B, Kjaer A (2005) Natriuretic peptides in the monitoring of anthracycline induced reduction in left ventricular ejection fraction. Eur J Heart Fail 7:87–93PubMedCrossRef

33.

Horacek JM, Pudil R, Tichy M, Jebavy L, Strasova A, Praus R, Zak P, Maly J (2005) The use of biochemical markers in cardiotoxicity monitoring in patients treated for leukemia. Neoplasma 52:430–434PubMed

34.

Okumura H, Iuchi K, Yoshida T, Nakamura S, Takeshima M, Takamatsu H, Ikeno A, Usuda K, Ishikawa T, Ohtake S, Matsuda T (2000) Brain natriuretic peptide is a predictor of anthracycline-induced cardiotoxicity. Acta Haematol 104:158–163PubMedCrossRef

Title: Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure
Authors: Aurélie Lefebvre
Suzanne Kural-Menasché
Michael Darmon
Guillaume Thiéry
Jean-Paul Feugeas
Benoît Schlemmer
Élie Azoulay
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1000-4

At a glance: The STEP trials

Springer Medicine

Use of N-terminal pro-brain natriuretic peptide to detect cardiac origin in critically ill cancer patients with acute respiratory failure

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2008

What type of monitoring has been shownto improve outcomes in acutely ill patients?

Plasma apolipoprotein CI correlates with increased survival in patients with severe sepsis

Comment on “Strict versus moderate glucose control after resuscitation from ventricular fibrillation” by Oksanen et al.

Acute respiratory failure: back to the roots!

Vasopressin vs. terlipressinin the treatmentof cardiovascular failure in sepsis

Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong