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Valor pronóstico del péptido natriurético proencefálico N-terminal en el plasma en pacientes con sepsis severa

Martina Brueckmann¹, Guenter Huhle, Siegfried Lang

¹First Department of Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany.

|July 20, 2005

Resumen

Los altos niveles de péptido natriurético proencefálico N-terminal (NT-proBNP) predicen la mortalidad en pacientes con sepsis severa. Este biomarcador puede ayudar a evaluar los resultados de supervivencia para la sepsis, ya que el tratamiento también afecta los niveles.

Área de la Ciencia:

Medicina de cuidados críticos Medicina de cuidados críticos.
Los biomarcadores cardiovasculares también son biomarcadores.
Sepsis Fisiopatología Fisiopatología Sepsis

Sus antecedentes:

El péptido natriurético auricular (ANP) y el péptido natriurético cerebral (BNP) predicen la disfunción cardíaca en la insuficiencia cardíaca y la enfermedad isquémica del corazón.
El valor pronóstico de los péptidos natriuréticos en la sepsis grave sigue sin caracterizarse.
Las formas prohormonas N-terminales (NT-proANP, NT-proBNP) fueron investigadas por su papel en los resultados de la sepsis.

Objetivo del estudio:

Determinar el valor pronóstico de NT-proANP y NT-proBNP en la sepsis severa.
Evaluar el efecto del tratamiento con drotrecogina alfa (activada) sobre los niveles de péptido natriurético en la sepsis.

Principales métodos:

Se incluyeron 57 pacientes con sepsis severa.
Niveles plasmáticos de NT-proANP y NT-proBNP medidos por ELISA en el día 2 de la sepsis.
Análisis de correlación entre los péptidos natriuréticos, la troponina I y los resultados de supervivencia.

Principales resultados:

Los niveles elevados de NT-proBNP (>1400 pmol/L) aumentaron significativamente el riesgo de mortalidad por sepsis (RR 3.9, P<0.01).
Los niveles de NT-proANP no predijeron la supervivencia.
Se encontró una correlación significativa entre la troponina I y el NT-proBNP (r=0,68, P<0,0001), lo que indica la participación de lesiones cardíacas.
El tratamiento con drotrecogina alfa (activada) se asoció con niveles más bajos de NT-proANP, NT-proBNP y troponina I.

Conclusiones:

NT-proBNP muestra potencial como un biomarcador pronóstico para la supervivencia en sepsis severa.
La lesión cardíaca, indicada por la troponina I, está relacionada con los niveles de NT-proBNP en la sepsis.
La drotrecogina alfa (activada) puede influir en el péptido natriurético y los marcadores de lesión cardíaca en la sepsis.

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