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Concentrations of ANP and BNP convey different types of information in Burn Intensive Care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

ANP and BNP have been thoroughly investigated in patients with critical illness. A direct comparison of their dynamics in severe burn injuries has so far not been undertaken. Their amino-terminal biologically inactive fragments (NT-proANP and NT-proBNP) in serum (S-) or in plasma (P-) were assessed daily for 14 days in 50 patients treated in Burn Intensive Care. Their mean age was 41.0 years (range 19-60) and their mean burn size was 30.5 % (range 10-95.5).

Both analytes showed a time dependent pattern with an increase followed by a plateau phase. S-NT-proANP exhibited less variability and reached its maximum days later than  P-NT-proBNP. The absolute values and the day-to-day changes for the two NPs correlated only moderately well, suggesting that they are controlled and expressed differently. There was a temporary decrease in the S-NT-proANP/P-NT-proBNP ratio that was most pronounced at days 4 and 5, a considerable inter- and intra-individual variability, and substantial day-to-day fluctuations.  P-CRP was a better predictor for P-NT-proBNP than for S-NT-proANP. Both NPs were predicted by Cardiovascular, Respiratory and Renal SOFA scores, although with some differences.

In conclusion, S-NT-proANP and P-NT-proBNP reflect severity of illness similarly in terms of Cardiovascular, Respiratory and Renal SOFA scores, notwithstanding a significantly larger intra-individual variability for P-NT-proBNP. An important difference between the two analytes is that P-NT-proBNP also reflects the systemic trauma response per se.

National Category
Medical and Health Sciences
Research subject
Plastic Surgery
Identifiers
URN: urn:nbn:se:uu:diva-198460OAI: oai:DiVA.org:uu-198460DiVA: diva2:618188
Available from: 2013-04-26 Created: 2013-04-15 Last updated: 2013-08-30
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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 908
Keyword
Burn, Injuries, Neuroendocrine, Intensive Care, Cortisol, Chromogranin A, Natriuretic peptides
National Category
Surgery
Research subject
Plastic Surgery
Identifiers
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)
Opponent
Supervisors
Available from: 2013-05-24 Created: 2013-04-15 Last updated: 2013-08-30

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