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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.


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Proatrial natriuretic peptide is a better predictor of 28-day mortality in septic shock patients than proendothelin-1

Caroline Guignant1 / Fabienne Venet1 / Nicolas Voirin2 / Françoise Poitevin1 / Christophe Malcus1 / Julien Bohé3 / Alain Lepape3 / Guillaume Monneret1

1Hospices Civils de Lyon, Hôpital E. Herriot, Laboratoire d'Immunologie, Lyon, France

2Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hygiène, Epidémiologie et Prévention and CNRS UMR 5558, Lyon, France

3Hospices Civils de Lyon, CH Lyon-Sud, Intensive Care Units, Lyon, France

Corresponding author: Guillaume Monneret, PharmD, PhD, Flow Cytometry Unit, Immunology Laboratory, Hôpital E. Herriot, 5, Place d'Arsonval, 69437 Lyon Cedex 03, France Phone: +33 4 72 11 97 58, Fax: +33 4 72 11 97 53,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 48, Issue 12, Pages 1813–1820, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2010.341, August 2010

Publication History

Received:
2010-01-21
Accepted:
2010-06-24
Published Online:
2010-08-13

Abstract

Background: Septic shock is a major health care problem that affects a heterogeneous population of patients. To improve sepsis management, a key point is to decrease this heterogeneity by stratifying patients according to specific criteria, such as appropriate biomarkers. As the early phase of septic shock is characterized by cardiovascular dysfunction, precursors of vasoactive hormones represent interesting candidates. The objective of the present study was to concomitantly assess the predictive value of C-terminal proendothelin-1 and midregional proatrial natriuretic peptide (CT-proET-1 and MR-proANP, respectively vasoconstrictor and vasodilator) on 28-day mortality following septic shock.

Methods: In this observational study which included 99 patients, concentrations of MR-proANP and CT-proET-1 were measured using an immunoluminometric assay three times within the first week after the onset of septic shock.

Results: While MR-proANP concentrations were significantly increased in non-survivors in comparison with survivors, no differences were noted for CT-proET-1. Increased MR-proANP concentrations were significantly associated with mortality after both univariate and multivariate analyses, adjusted for usual clinical confounders [SAPS II (simplified acute physiology score II), SOFA (sepsis-related organ failure assessment) scores and number of co-morbidities].

Conclusions: In septic shock patients, MR-proANP appears to be a good predictor of 28-day mortality, whereas CT-proET-1 does not present any predictive value during monitoring.

Clin Chem Lab Med 2010;48:1813–20.

Keywords: atrial natriuretic factor; endothelin-1; mortality; prognosis; septic shock

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