tailieunhanh - Báo cáo y học: "The interpretation of brain natriuretic peptide in critical care patients; will it ever be useful"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: The interpretation of brain natriuretic peptide in critical care patients; will it ever be useful? | Dixon and Philips Critical Care 2010 14 184 http content 14 4 184 CRITICAL CARE COMMENTARY L__ The interpretation of brain natriuretic peptide in critical care patients will it ever be useful John Dixon1 and Barbara Philips2 3 See related research by Di Somma etal. http content 14 3 R116 Abstract The measurement of B-type natriuretic peptide BNP is recommended for the diagnosis of decompensated heart failure the prognosis of chronic heart failure is worse if BNP is increased and studies suggest that BNP is useful to guide therapy. A study by Di Somma and colleagues adds to the body of evidence showing that patients with a marked decrease in BNP concentrations during their hospital admission are less likely to be readmitted with a further adverse cardiac event than patients in whom BNP fails to decrease. However the wider interpretation of BNP concentrations in critically ill patients with other conditions remains uncertain. Patients hospitalised for decompensated heart failure DHF have a high mortality are at increased risk of further cardiovascular events and experience frequent re-admissions to hospital the accurate identification of high-risk patients before discharge remains a significant clinical challenge. Di Somma and colleagues 1 suggest that changes in B-type natriuretic peptide BNP concentration measured at admission after 24 hours and at discharge may be useful in identifying patients at risk of readmission with a cardiac adverse event after hospitalization for DHF. In their Italian multicentre study a decrease in BNP concentration of 25 24 hours after admission to hospital and a 46 decrease at discharge were strong negative prognostic factors for future cardiovascular events. An absolute BNP concentration of 300 pg ml at discharge was also negatively predictive. Combined the predictive value was improved with a change in BNP concentration of 46 at discharge with an absolute BNP concentration of 300 pg ml giving an .