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Critical Care
Published in: Critical Care 1/2005

Open Access 01-02-2004 | Research

Pro-atrial natriuretic peptide is a prognostic marker in sepsis, similar to the APACHE II score: an observational study

Authors: Nils G Morgenthaler, Joachim Struck, Mirjam Christ-Crain, Andreas Bergmann, Beat Müller

Published in: Critical Care | Issue 1/2005

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Abstract

Introduction

Additional biomarkers in sepsis are needed to tackle the challenges of determining prognosis and optimizing selection of high-risk patients for application of therapy. In the present study, conducted in a cohort of medical intensive care unit patients, our aim was to compare the prognostic value of mid-regional pro-atrial natriuretic peptide (ANP) levels with those of other biomarkers and physiological scores.

Methods

Blood samples obtained in a prospective observational study conducted in 101 consecutive critically ill patients admitted to the intensive care unit were analyzed. The prognostic value of pro-ANP levels was compared with that of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and with those of various biomarkers (i.e. C-reactive protein, IL-6 and procalcitonin). Mid-regional pro-ANP was detected in EDTA plasma from all patients using a new sandwich immunoassay.

Results

On admission, 53 patients had sepsis, severe sepsis, or septic shock, and 68 had systemic inflammatory response syndrome. The median pro-ANP value in the survivors was 194 pmol/l (range 20–2000 pmol/l), which was significantly lower than in the nonsurvivors (median 853.0 pmol/l, range 100–2000 pmol/l; P < 0.001). On the day of admission, pro-ANP levels, but not levels of other biomarkers, were significantly higher in surviving than in nonsurviving sepsis patients (P = 0.001). In a receiver operating characteristic curve analysis for the survival of patients with sepsis, the area under the curve (AUC) for pro-ANP was 0.88, which was significantly greater than the AUCs for procalcitonin and C-reactive protein, and similar to the AUC for the APACHE II score.

Conclusion

Pro-ANP appears to be a valuable tool for individual risk assessment in sepsis patients and for stratification of high-risk patients in future intervention trials. Further studies are needed to validate our results.
Appendix
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Metadata
Title
Pro-atrial natriuretic peptide is a prognostic marker in sepsis, similar to the APACHE II score: an observational study
Authors
Nils G Morgenthaler
Joachim Struck
Mirjam Christ-Crain
Andreas Bergmann
Beat Müller
Publication date
01-02-2004
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3015

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