The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock

ABSTRACT Sepsis continues to be a leading public health burden in the United States and worldwide. With the increasing use of advanced laboratory technology, there is a renewed interest in the use of biomarkers in sepsis to aid in more precise and targeted decision-making. Natriuretic peptides have been increasingly recognized to play a role outside of heart failure. They are commonly elevated among critically ill patients in the setting of cardiopulmonary dysfunction and may play a role in identifying patients with sepsis and septic shock. There are limited data on the role of these biomarkers in the diagnosis, management, outcomes and prognosis of septic patients. This review seeks to describe the role of natriuretic peptides in fluid resuscitation, diagnosis of ventricular dysfunction and outcomes and the prognosis of patients with sepsis. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have been noted to be associated with left ventricular systolic and diastolic and right ventricular dysfunction in patients with septic cardiomyopathy. BNP/NT-proBNP may predict fluid responsiveness, and trends of these peptides may play a role in fluid resuscitation. Despite suggestions of a correlation with mortality, the role of BNP in mortality outcomes and prognosis during sepsis needs further evaluation.</p

MOESM2 of Impact of individualized target mean arterial pressure for septic shock resuscitation on the incidence of acute kidney injury: a retrospective cohort study

Additional file 2: Fig. S2. Quartile of ΔMAP and highest stage of severity of AKI during hospitalization (p-value = .03). Abbreviations: MAP, mean arterial pressure; AKI, acute kidney injury

Odds ratios for the association between admission serum albumin levels and hospital acquired acute kidney injury (HAKI) occurrence.

Odds ratios for the association between admission serum albumin levels and hospital acquired acute kidney injury (HAKI) occurrence.</p

MOESM1 of Impact of individualized target mean arterial pressure for septic shock resuscitation on the incidence of acute kidney injury: a retrospective cohort study

Additional file 1: Fig. S1. Quartile of ΔMAP and Incidence of AKI (p-value = .03). Abbreviations: MAP, mean arterial pressure; AKI, acute kidney injury

Study definitions of hypotension, tachycardia, hypoperfusion, deterioration and refractory shock.

Data from Jentzer, et al. J Am Coll Cardiol 2019. (DOCX)</p

Bar graph demonstrating the relationship between mechanical support devices, vasoactive medications, and mechanical ventilation on mortality stratified by SI.

Bar graph demonstrating the relationship between mechanical support devices, vasoactive medications, and mechanical ventilation on mortality stratified by SI.</p

Table 1 - Association between the shock index on admission and in-hospital mortality in the cardiac intensive care unit

Table 1 - Association between the shock index on admission and in-hospital mortality in the cardiac intensive care unit</p

Line graph demonstrating the relationship between SI and mortality.

Line graph demonstrating the relationship between SI and mortality.</p

Fig 2 -

A. Bar graph and line graph demonstrating the relationship of HR on mortality. B. Bar graph and line graph demonstrating the relationship of SBP on mortality.</p

Variables used for multi-variable logistic regression model.

Variables used for multi-variable logistic regression model.</p