Mid-regional pro-atrial natriuretic peptide as a biomarker of left ventricular systolic dysfunction in patients with sepsis
DOI:
https://doi.org/10.13181/mji.v28i2.1952Keywords:
biomarkers, left ventricular dysfunction, atrial natriuretic peptide, tumor necrosis factor-alphaAbstract
BACKGROUND Releasing cytokine pro inflammation in patients with sepsis (tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β) and IL-6) with other factors (mid regional pro atrial natriuretic peptide [MR-proANP] and TNF-α) will cause left ventricular systolic dysfunction (LVSD). This research aimed to prove MR-proANP as a biomarker of LVSD in sepsis, area under the curve (AUC), sensitivity, specificity, cut-off point and probability of MR-proANP and TNF-α as a biomarker of LVSD.
METHODS Non-experimental diagnostic test with cross sectional design and simple random sampling. Variable examined consisted of MR pro ANP, TNF-α and left ventricular ejection fraction (LVEF). LVSD if LVEF was ≤45%. Statistical analysis using 2 x 2 table and receiver operating characteristic curve using SPSS 22 for window.
RESULTS There were examined 71 patients from November 2013 to March 2014 in tertiary ICU of Moewardi Hospital. There were 22 patients with mild sepsis (30.9%), 40 patients with severe sepsis (56.4%) and 9 patients with septic shock (12.7%). The AUC value of MR-proANP level was 0.84 (95% CI 0.73-0.95), p < 0.001. Optimal cut off point was ≥225.95 pmol/l and diagnostic odd ratio (DOR) was 12.11. The AUC value of TNF-α level was 0.73 (95% CI 0.60-0.86), p < 0.002. Optimal cut-off point was ≥7.36 pg/ml and DOR was 5.03. Multivariate analysis was resulted that MR-proANP was the best predictor of LVSD (AUC 0.78), and TNF-α (0.69).
CONCLUSIONS MR-proANP could be used as a biomarker and the best diagnostic predictor of LVSD.
Downloads
References
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296-327. https://doi.org/10.1097/01.CCM.0000298158.12101.41
Flierl MA, Rittirsch D, Huber-Lang MS, Sarma JV, Ward PA. Molecular events in the cardiomyopathy of sepsis. Mol Med. 2008;14(5-6):327-36. https://doi.org/10.2119/2007-00130.Flierl
Fernandes CJ Jr, de Assuncao MS. Myocardial dysfunction in sepsis: a large, unsolved puzzle. Crit Care Res Pract. 2012;2012:896430. https://doi.org/10.1155/2012/896430
Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarker of sepsis in critical care. J Antimicrob Chemother. 2011;66(Suppl 2):ii33-40. https://doi.org/10.1093/jac/dkq523
Ladetzki-Baehs K, Keller M, Kiemer AK, Koch E, Zahler S, Wendel A, et al. Atrial natriuretic peptide, a regulator of nuclear factor kB activation in vivo. Endocrinology. 2007;148(1):332-6. https://doi.org/10.1210/en.2006-0935
Kiemer AK, Vollmar AM. The atrial natriuretic peptide regulates the production of inflammatory mediators in macrophages. Ann Rheum Dis. 2001;60(Suppl 3):iii68-70.
Lipinska-Gediga M, Mierzchala M, Durek G. Pro-atrial natriuretic peptide (pro-ANP) level in patients with severe sepsis and septic shock: prognostic and diagnostic significance. Infection. 2012;40(3):303-9. https://doi.org/10.1007/s15010-011-0235-0
Morgenthaler NG, Struck J, Christ-Crain M, Bergmann A, Müller B. Pro-atrial natriuretic peptide is a prognostic marker in sepsis, similar to the APACHE II score: an observational study. Crit Care. 2005;9(1):R37-45. https://doi.org/10.1186/cc3015
Celes MR, Prado CM, Rossi MA. Sepsis: going to the heart of the matter. Pathobiology. 2013;80(2):70-86. https://doi.org/10.1159/000341640
de Backer D, Cholley BP, Slama M, Vieillard-Baron A, Vignon P. Hemodynamic Monitoring Using Echocardiography in the Critically Ill. Septic Shock 2011. https://doi.org/10.1007/978-3-540-87956-5
Jozwiak M, Persichini R, Monnet X, Teboul JL. Management of myocardial dysfunction in severe sepsis. Semin Respir Crit Care Med. 2011;32(2):206-14. https://doi.org/10.1055/s-0031-1275533
Zanotti Cavazzoni SL, Guglielmi M, Parrillo JE, Walker T, Dellinger RP, Hollenberg SM. Ventricular dilation is associated with improved cardiovascular performance and survival in sepsis. Chest. 2010;138(4):848-55. https://doi.org/10.1378/chest.09-1086
Griffee MJ, Merkel MJ, Wei KS. The role of echocardiography in hemodynamic assessment of septic shock. Crit Care Clin. 2010;26(2):365-82. https://doi.org/10.1016/j.ccc.2010.01.001
Oliver JC, Bland LA, Oettinger CW, Arduino MJ, McAllister SK, Aguero SM, et al. Cytokine kinetics in an in vitro whole blood model following an endotoxin challenge. Lymphokine Cytokine Res. 1993;12(2):115-20.
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
