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Open Access Research article

Usefulness of N-terminal pro-B-type natriuretic peptide in patients admitted to the intensive care unit: a multicenter prospective observational study

Chin Kook Rhee1, So Yeon Lim2, Shin Ok Koh3, Won-Il Choi4, Young-Joo Lee5, Gyu Rak Chon6, Je Hyeong Kim7, Jae Yeol Kim8, Jaemin Lim9, Sunghoon Park10, Ho Cheol Kim11, Jin Hwa Lee12, Ji Hyun Lee13, Jisook Park14, Younsuck Koh15, Gee Young Suh2, Seok Chan Kim1* and Validation of Simplified acute physiology score3 in Korean Intensive care unit (VSKI) study group & the Korean study group on respiratory failure (KOSREF)

Author Affiliations

1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505 Banpo-Dong, Seoul, Seocho-Gu 137-701, South Korea

2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

3 Division of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, Severance Hospital, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea

4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Keimyung University, Dongsan Hospital, Daegu, South Korea

5 Department of anesthesiology, Aju university college of medicine, Suwon, South Korea

6 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chungju hospital, School of medicine of Konkuk University, Chungju, South Korea

7 Sleep and Critical Care Medicine, Department of Medicine, Korea University Ansan Hospital, Ansan, South Korea

8 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chung-Ang University College of Medicine, Seoul, South Korea

9 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, Gangneung, University of Ulsan Medical College of internal medicine, Gangneung, South Korea

10 Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Ahnyang, South Korea

11 Division of Pulmonary and Critical Care Medicine, Department of Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea

12 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, South Korea

13 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bundang CHA hospital CHA University, Bundang, South Korea

14 Department of Multimedia, Seoul Women’s University, Seoul, South Korea

15 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

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BMC Anesthesiology 2014, 14:16  doi:10.1186/1471-2253-14-16

Published: 10 March 2014

Abstract

Background

The role of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) as a prognostic factor in patients admitted to the intensive care unit (ICU) is not yet fully established. We aimed to determine whether NT-pro-BNP is predictive of ICU mortality in a multicenter cohort of critically ill patients.

Methods

A total of 1440 patients admitted to 22 ICUs (medical, 14; surgical, six; multidisciplinary, two) in 15 tertiary or university-affiliated hospitals between July 2010 and January 2011 were assessed. Patient data, including NT-pro-BNP levels and Simplified Acute Physiology Score (SAPS) 3 scores, were recorded prospectively in a web-based database.

Results

The median age was 64 years (range, 53–73 years), and 906 (62.9%) patients were male. The median NT-pro-BNP level was 341 pg/mL (104–1,637 pg/mL), and the median SAPS 3 score was 57 (range, 47–69). The ICU mortality rate was 18.9%, and hospital mortality was 24.5%. Hospital survivors showed significantly lower NT-pro-BNP values than nonsurvivors (245 pg/mL [range, 82–1,053 pg/mL] vs. 875 pg/mL [241–5,000 pg/mL], respectively; p < 0.001). In prediction of hospital mortality, the area under the curve (AUC) for NT-pro-BNP was 0.67 (95% confidence interval [CI], 0.64–0.70) and SAPS 3 score was 0.83 (95% CI, 0.81–0.85). AUC increment by adding NT-pro-BNP is minimal and likely no different to SAPS 3 alone.

Conclusions

The NT-pro-BNP level was more elevated in nonsurvivors in a multicenter cohort of critically ill patients. However, there was little additional prognostic power when adding NT-pro-BNP to SAPS 3 score.

Keywords:
N-terminal pro-B-type natriuretic peptide; Intensive care unit; Critical care; Prognosis