The atrial natriuretic peptide does not serve osmoregulation but predicts outcome following brain injury

Dynamic detection of N-terminal pro-B-type natriuretic peptide helps to predict the outcome of patients with major trauma

INTRODUCTION

NT-proBNP and BNP have been demonstrated to be prognostic markers in cardiac disease and sepsis. However, the prognostic value and the dynamic changes of BNP or NT-proBNP in trauma patients remain unclear. The present study was conducted to investigate the dynamic changes of NT-proBNP in patients with major trauma (injury severity score ≥16), determine whether NT-proBNP could be used as a simple index to predict mortality in major trauma patients.

METHODS

This prospective observational study included 60 patients with major trauma. Serum NT-proBNP levels were measured on the 1st, 3rd and 7th day after injury The NT-proBNP levels in survivors were compared with those in non-survivors. The efficacy of NT-proBNP to predict survival was analyzed using receiver operating characteristic curves. An analysis of correlations between NT-proBNP and various factors, including injury severity score, Glasgow coma score, acute physiology and chronic health evaluation II, central venous pressure, creatine kinase-MB, cardiac troponin I and procalcitonin (PCT) was performed. NT-proBNP levels in patients with traumatic brain injury were compared with those in patients without traumatic brain injury. A comparison of NT-proBNP levels between patients with and without sepsis was also performed at each time point.

RESULTS

NT-proBNP levels in non-survivors were significantly higher than those in survivors at all the indicated time points. In the group of non-survivors, NT-proBNP levels on the 7th day were markedly higher than those on the 1st day. In contrast, NT-proBNP levels in survivors showed a reduction over time. The efficacy of NT-proBNP to predict survival was analyzed using ROC curves, and there was no difference in the area under the ROC between NT-proBNP and APACHE II/ISS at the three time points. A significant correlation was found between NT-proBNP and ISS on the 1st day, NT-proBNP and CK-MB, Tn-I and APACHE II on the 3rd day, NT-proBNP and PCT on the 7th day. There were no significant differences in NT-proBNP levels between patients with or without brain trauma at all the indicated time points. NT-proBNP levels in patients with sepsis were significantly higher than those in patients without sepsis at all the indicated time points.

CONCLUSION

These findings suggest that dynamic detection of serum NT-proBNP might help to predict death in patients with major trauma. A high level of NT-proBNP at admission or maintained for several days after trauma indicates poor survival.

Correlations of ANP genetic polymorphisms and serum levels with ischemic stroke risk: a meta-analysis

AIMS

This meta-analysis was performed to evaluate the correlations between atrial natriuretic peptide (ANP) genetic polymorphism and its serum ANP levels with the risk of ischemic stroke.

METHODS

The PubMed, CISCOM, CINAHL, Web of Science, Google Scholar, EBSCO, Cochrane Library, and CBM databases were searched for relevant articles published before October 1st, 2013 without language restrictions. Meta-analysis was conducted using the STATA 12.0 software. Crude odds ratios (ORs) or standardized mean difference (SMD) with their 95% confidence interval (95% CI) were calculated. Twelve case-control studies that met all inclusion criteria were included in this meta-analysis. A total of 1285 patients with ischemic stroke and 1088 healthy control subjects were involved in this meta-analysis. Three common single-nucleotide polymorphisms (1837 G/A, 2238 T/C, and 664 G/A) in the ANP gene were assessed.

RESULTS

Our meta-analysis results revealed that ANP 2238 T/C polymorphism might increase the risk of ischemic stroke (C allele vs. T allele: OR=2.26, 95% CI: 1.59-3.23, p<0.001; TC+CC vs. TT: OR=2.26, 95% CI: 1.34-3.81, p=0.002; respectively). However, we found no correlations of ANP 1837 G/A and 664 G/A polymorphisms with ischemic stroke risk (all p>0.05). Furthermore, ischemic stroke patients had higher levels of serum ANP than those of healthy control subjects (SMD=3.12, 95% CI: 1.16-5.07, p=0.002). Our study revealed no publication bias in this meta-analysis (all p>0.05).

CONCLUSION

Our findings indicate that ANP genetic polymorphism and serum ANP levels may contribute to the development of ischemic stroke. Thus, the ANP genetic polymorphism and serum ANP levels could be potential biomarkers for early detection of ischemic stroke.