Background: The cardiac correlates, if any, of N-terminal probrain natriuretic peptide (NT-proBNP) levels in septic and non-septic shock patients remain controversial. Methods: In the 38 septic and 22 non-septic shock patients in the transpulmonary thermodilution arm of a previous 2-center randomized controlled trial comparing pulmonary artery catheterization with transpulmonary thermodilution, serial (daily for 3 days) and paired measurements (n = 145) were obtained of NT-proBNP and transpulmonary dilution variables as global ejection fraction (GEF), left ventricular preload-recruitable stroke work (PRSW) and diastolic compliance. Results: Elevated NT-proBNP inversely related to low GEF and PRSW in pooled data (r = -0.45, P < 0.001). The 72 h course of NT-proBNP was inversely associated with PRSW, independent of age, gender, creatinine, norepinephrine treatment and diastolic compliance, without differences between septic and non-septic shock. Over the 72 h study period, NT-proBNP levels were higher in 28 day non-survivors than survivors, independent of type of shock and disease severity. Conclusions: In septic and non-septic shock, NT-proBNP elevations reflect systolic left ventricular dysfunction and are associated with a poor outcome. They may help recognition of cardiac dysfunction in shock and its management when invasive hemodynamic monitoring is not yet instituted.

Cardiac function, Natriuretic peptides, Renal function, Sepsis, Shock, Transpulmonary thermodilution,
IJC Metabolic and Endocrine
Department of Intensive Care

Groeneveld, A.B.J, & Trof, R.J. (2016). N-terminal-pro-brain natriuretic peptide elevations in the course of septic and non-septic shock reflect systolic left ventricular dysfunction assessed by transpulmonary thermodilution. IJC Metabolic and Endocrine, 10, 30–35. doi:10.1016/j.ijcme.2016.01.002