RESUMO
Plasma concentrations of the stable endothelin-1 precursor, C-terminal portion of the endothelin-1 precursor, determined prospectively in 293 newborn infants (gestational age, 24-41 weeks) at birth and on day 3 of life were unrelated to gestational age at birth, but strongly associated with respiratory distress when measured on day 3 of life.
Assuntos
Endotelina-1/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue , Displasia Broncopulmonar/sangue , Sangue Fetal/química , Idade Gestacional , Humanos , Recém-NascidoRESUMO
OBJECTIVE: This study aimed to investigate the correlation of midregional pro-atrial natriuretic peptide (MR-proANP) with severity of septic status in patients with ventilator-associated pneumonia (VAP) and the usefulness of MR-proANP for mortality prediction in VAP. DESIGN: Prospective observational cohort study. SETTING: University Hospital. PATIENTS: Seventy-one patients consecutively admitted to ICU who developed VAP. Patients were followed for 28 days after diagnosis, when they were considered survivors. There were no interventions. RESULTS: MR-proANP levels increased from sepsis to severe sepsis and septic shock on D0 and D4 of VAP (0.002 and 0.02 respectively). Median MR-proANP levels on day 0 and day 4 (pmol/L [interquartile range]) were 149.0 (79.8-480.0) and 249.0 (93.6-571.0) in septic patients, 438.5 (229.3-762.0) and 407.5 (197.8-738.0) in severe sepsis, 519.5 (369.5-1282.3) and 632.0 (476.0-1047.5) in septic shock. On day 0 and day 4, MR-proANP levels were significantly higher in non-survivors (525.0 [324.0-957.8] and 679.5 [435.0-879.5], respectively) than in survivors (235.0 [102.0-535.0] and 254.0 [110.0-571.0], respectively; P = 0.004). Univariate logistic regression model for mortality included age, gender, APACHE II score, creatinine, logarithmic transformed MR-proANP (LnMR-proANP). Mortality was directly related to LnMR-proANP on D0 and D4, with odds ratios (OR) of 2.06 (95% CI 1.21-3.51) and 2.63 (1.33-5.23), respectively. In multivariate logistic regression, only LnMR-proANP D0 with OR = 2.35 (1.05-5.26) and LnMR-proANP D4 with OR = 3.76 (1.39-10.18) remained significant. CONCLUSIONS: Our data demonstrated that MR-proANP levels increase progressively with the severity of sepsis and are independent predictors of mortality in VAP.
Assuntos
Fator Natriurético Atrial/sangue , Pneumonia Associada à Ventilação Mecânica/sangue , Sepse/sangue , Biomarcadores/sangue , Brasil/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/mortalidade , Pneumonia Associada à Ventilação Mecânica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Sepse/mortalidade , Sepse/fisiopatologia , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Taxa de SobrevidaRESUMO
BACKGROUND: The present study sought to investigate the correlation of copeptin with the severity of septic status in patients with ventilator-associated pneumonia (VAP), and to analyze the usefulness of copeptin as a predictor of mortality in VAP. METHODS: The prospective observational cohort study was conducted in a teaching hospital. The subjects were 71 patients consecutively admitted to the intensive care unit from October 2003 to August 2005 who developed VAP. Copeptin levels were determined on day 0 and day 4 of VAP. Patients were followed for 28 days after the diagnosis, when they were considered survivors. Patients who died before day 28 were classified as nonsurvivors. There were no interventions. RESULTS: Copeptin levels increased from sepsis to severe sepsis and septic shock both on day 0 and day 4 (P = 0.001 and P = 0.009, respectively). Variables included in the univariable logistic regression analysis for mortality were age, gender, Acute Physiology and Chronic Health Evaluation II score and ln copeptin on day 0 and day 4. Mortality was directly related to ln copeptin levels on day 0 and day 4, with odds ratios of 2.32 (95% confidence interval, 1.25 to 4.29) and 2.31 (95% confidence interval, 1.25 to 4.25), respectively. In a multivariable logistic regression model for mortality, only ln copeptin on day 0 with odds ratio 1.97 (95% confidence interval, 1.06 to 3.69) and ln copeptin on day 4 with odds ratio 2.39 (95% confidence interval, 1.24 to 4.62) remained significant. CONCLUSION: Our data demonstrate that copeptin levels increase progressively with the severity of sepsis and are independent predictors of mortality in VAP.