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Natriuretic peptide type B in burn intensive care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemical endocrinology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
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2013 (English)In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755; 2163-0763, Vol. 74, no 3, 855-861 p.Article in journal (Refereed) Published
Abstract [en]


The plasma concentration of natriuretic peptide type B (BNP) or NT-proBNP (P-BNP or P-NT-proBNP) reflects cardiac load. In intensive care unit settings and in chronic inflammation, it is also affected by non-heart-related mechanisms. It has been suggested to be a marker of hydration after severe burns and to predict outcome in critically ill patients, but results are contradictory. We therefore measured P-NT-proBNP after severe burns and related it to injury related variables and to organ dysfunction.


Fifty consecutive patients with a burn size greater than 10% were studied for the first 2 weeks. P-NT-proBNP changes were analyzed in relation to burn size, age, changes in body weight, C-reactive protein in plasma, and organ function assessed as Sequential Organ Failure Assessment (SOFA) scores


P-NT-proBNP showed large day-to-day and between patient variations. Daily change in body weight correlated with P-NT-proBNP only on Day 2, when maximum mobilization of edema occurred. Thereafter, P-NT-proBNP correlated with C-reactive protein in plasma as well as with SOFA scores. Burn size correlated with maximal weight change, which in turn correlated with both time for and value of maximum P-NT-proBNP. Maximal P-NT-proBNP was related to mortality and correlated better with SOFA score on Day 14 compared with age and burn size. In linear regressions, together with age at injury and total body surface area, P-NT-proBNP assessed on Days 3 to 8 was an independent predictor for every subsequent SOFA score measured one or more days later up to Day 14.


P-NT-proBNP exhibited considerable interindividual and day-to-day variations. Values were related to mortality, burn size, water accumulation, posttraumatic response, and organ function. Maximum P-NT-proBNP correlated stronger with length of stay and with organ function on Day 14, compared with age and burn size. High values in Days 3 through 8 were also independent predictors of subsequent organ function up to 2 weeks after injury.


Epidemiologic/prognostic study, level III.

Place, publisher, year, edition, pages
2013. Vol. 74, no 3, 855-861 p.
National Category
URN: urn:nbn:se:uu:diva-197866DOI: 10.1097/TA.0b013e31827e154aISI: 000316321900030PubMedID: 23425748OAI: oai:DiVA.org:uu-197866DiVA: diva2:614546
Available from: 2013-04-05 Created: 2013-04-05 Last updated: 2015-02-27
In thesis
1. Neuroendocrine Stress Response after Burn Trauma
Open this publication in new window or tab >>Neuroendocrine Stress Response after Burn Trauma
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Some aspects of the stress response during acute intensive care for severe burns are described and quantified by measuring hormonal and neuroendocrine patterns and relating these to organ function in the short term. This includes an assessment of whether there are markers for the severity of stress that are better than conventional descriptors of the severity of a burn in predicting failing organ function.

P-CgA after a major burn injury is an independent and better predictor of organ dysfunction assessed as SOFA score than the traditionally used TBSA% burned. The results also suggest that the extent of neuroendocrine activation is related to organ dysfunction, and this motivates a more extensive effort to evaluate P-CgA as a prognostic marker with respect to mortality and long-term outcome.

P-NT-proBNP exhibited a complex pattern with considerable inter-individual and day-to-day variations. Values of P-NT-proBNP were related to size of burn, water accumulation and systemic inflammatory response. A considerable covariation with trauma response and SOFA scores was observed in day by day analyses, but with weight change only on day 2.

Maximum P-NT-proBNP showed a stronger correlation with SOFA score on day 14, with mortality, and with LOS, than did age and TBSA% burned. High values were also independent predictors of all subsequent SOFA scores up to two weeks after injury.

P-NT-proBNP and NT-proANP reflect and predict organ function after burn injury similarly, notwithstanding a significantly larger intra-individual variability for P-NT-proBNP. P-NT-proBNP, but not NT-proANP, reflects the systemic inflammatory trauma response.

Free cortisol concentration was related to the size of burns, as was the circadian cortisol rhythm. This effect of burn size was, at least in part, related to its effect on organ function.

This thesis points to the fact that the stress response is richly interwoven, and cannot be adequately assessed by one biomarker only. All biomarkers studied here can be viewed as representing efferent limbs of the stress reaction, and they would need to be supplemented by biomarkers representing individual physiologic responses that follow the stress signaling.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 908
Burn, Injuries, Neuroendocrine, Intensive Care, Cortisol, Chromogranin A, Natriuretic peptides
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Research subject
Plastic Surgery
urn:nbn:se:uu:diva-198466 (URN)978-91-554-8686-0 (ISBN)
Public defence
2013-06-14, Skoogsalen, Entrance 78-79, Akademiska Sjukhuset, Uppsala, 09:15 (Swedish)
Available from: 2013-05-24 Created: 2013-04-15 Last updated: 2013-08-30

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Lindahl, Andreas EStridsberg, MatsEkselius, LisaGerdin, Bengt
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Plastic SurgeryBiochemical endocrinologyPsychiatry, University Hospital

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