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Review
. 2019 Oct 14;31(3):368-378.
doi: 10.5935/0103-507X.20190060. eCollection 2019.

The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock

[Article in Portuguese, English]
Govind Pandompatam  1 , Kianoush Kashani  2 , Saraschandra Vallabhajosyula  1   3
Affiliations
Review

The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock

[Article in Portuguese, English]
Govind Pandompatam et al. Rev Bras Ter Intensiva. .

Abstract
in English, Portuguese

Sepsis continues to be a leading public health burden in the United States and worldwide. With the increasing use of advanced laboratory technology, there is a renewed interest in the use of biomarkers in sepsis to aid in more precise and targeted decision-making. Natriuretic peptides have been increasingly recognized to play a role outside of heart failure. They are commonly elevated among critically ill patients in the setting of cardiopulmonary dysfunction and may play a role in identifying patients with sepsis and septic shock. There are limited data on the role of these biomarkers in the diagnosis, management, outcomes and prognosis of septic patients. This review seeks to describe the role of natriuretic peptides in fluid resuscitation, diagnosis of ventricular dysfunction and outcomes and the prognosis of patients with sepsis. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have been noted to be associated with left ventricular systolic and diastolic and right ventricular dysfunction in patients with septic cardiomyopathy. BNP/NT-proBNP may predict fluid responsiveness, and trends of these peptides may play a role in fluid resuscitation. Despite suggestions of a correlation with mortality, the role of BNP in mortality outcomes and prognosis during sepsis needs further evaluation.

A sepse persiste como importante sobrecarga à saúde pública nos Estados Unidos e em todo o mundo. Com o crescente uso de tecnologias laboratoriais, tem se renovado o interesse na utilização de biomarcadores na sepse, para auxiliar em um processo mais preciso e direcionado para tomadas de decisão. Os peptídeos natriuréticos vem sendo cada vez mais reconhecidos por seu papel que vai além da insuficiência cardíaca. Estes peptídeos estão comumente elevados em pacientes críticos que apresentam condições de disfunção cardiopulmonar e podem ter papel na identificação de pacientes com sepse e choque séptico. São poucos os dados disponíveis em relação ao papel destes biomarcadores no diagnóstico, no controle, nos desfechos e no prognóstico de pacientes sépticos. Esta revisão procura descrever o papel dos peptídeos natriuréticos na ressuscitação volêmica, no diagnóstico de disfunção ventricular, nos desfechos e no prognóstico de pacientes com sepse. Tem sido observado que o peptídeo natriurético tipo B (BNP) e o fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP) se associam com disfunção ventricular sistólica e diastólica, tanto esquerda quanto direita, em pacientes com cardiomiopatia séptica. O BNP e o NT-proBNP podem predizer a responsividade a volume, e as tendências de medidas seriadas destes peptídeos podem ser importantes na ressuscitação volêmica. A despeito da sugestão de correlação com mortalidade, o papel do BNP nos desfechos de mortalidade e prognóstico, durante a sepse, ainda necessita melhor avaliação.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Mechanisms of release and action of natriuretic peptides. PH - pulmonary hypertension; ARDS - acute respiratory distress syndrome; PE - pulmonary embolism; COPD - chronic obstructive pulmonary disease; BNP - B-type natriuretic peptide; NT pro-BNP - N-terminal pro-B-type natriuretic peptide; PEEP - positive end-expiratory pressure; CNS - central nervous system; RAAS - renin-angiotensin-aldosterone system.
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