Krenov K. Yu., Sukhodolia A. I.

DETERMINATION OF THE DYNAMICS OF NATRIURETIC PEPTIDE IN RESPONSE TO VOLUME LOAD IN PATIENTS WITH ACUTE SURGICAL PATHOLOGY OF THE ABDOMINAL CAVITY

---

Show/Download

About the author:

Krenov K. Yu., Sukhodolia A. I.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

Annotation:

The study of biomarkers in critically ill patients facilitates the diagnosis and classification of life-threatening conditions, aids in prognosis determination, and enhances the monitoring of responses to intensive therapy. The aim is to examine the dynamics of natriuretic peptide levels in response to a bolus infusion of 0.9% NaCl in patients with acute surgical pathology of the abdominal cavity and intra-abdominal hypertension. This study included 30 patients with acute surgical pathology of the abdominal cavity, with a mean age of 56.6±18.39 years. During the initial phase, following stabilization, measurements were taken for intra-abdominal pressure, abdominal perfusion pressure, and natriuretic peptide levels. Each patient then received a bolus infusion of 0.9% NaCl (400 ml over 60 minutes). The same parameters were reassessed post-infusion. Subsequently, patients were categorized based on the presence or absence of intra-abdominal hypertension. Parameters were calculated, and correlations were analyzed using statistical methods. Data analysis was performed using Microsoft Excel spreadsheet formulas, which included the calculation of mean values for the groups, standard deviations for each group, and two-sample t-tests with unequal variances. The average intra-abdominal pressure (IAP) was 11.56±5.48 mm Hg, the abdominal perfusion pressure (APP) was 66.18±13.18 mm Hg, and NT-proBNP levels were 2143.92±3194.14 pg/mL. After administering a bolus of 0.9% NaCl, the IAP at the 60th minute was 11.92±4.43 mm Hg, APP was 66.57±13.16 mm Hg, and NT-proBNP levels were 2548.81±3194.14 pg/mL (p≥0.05). Analyzing the dynamics of natriuretic peptide levels in groups with and without intra-abdominal hypertension showed no significant differences at 0 minutes (4499.55±4016.78 pg/mL vs. 1825.87±938.04 pg/mL) or at the 60th minute (5156.97±4742.56 pg/mL vs. 1924.09±1027.38 pg/mL). However, the results approached statistical significance (p=0.059 and p=0.062, respectively). The use of biomarkers in critical care medicine represents a promising advancement and a crucial step toward personalized intensive therapy. Incorporating this approach into strategies for improved risk stratification, disease progression monitoring, and treatment optimization is essential. The family of natriuretic peptides may serve as a valuable tool for assessing the cardiovascular system's response to volemic load in patients with intra-abdominal hypertension.

Tags:

Bibliography:

1. Plata-Menchaca EP, Ruiz-Rodríguez JC, Ferrer R. Early Diagnosis of Sepsis: The Role of Biomarkers and Rapid Microbiological Tests. Seminars in Respiratory and Critical Care Medicine. 2024;45(04):479-90. DOI: http://dx.doi.org/10.1055/s-0044-1787270.
2. Ostermann M, Legrand M, Meersch M, Srisawat N, Zarbock A, Kellum JA. Biomarkers in acute kidney injury. Annals of Intensive Care. 2024;14(1):145. DOI: http://dx.doi.org/10.1186/s13613-024-01360-9.
3. Takahashi H, Wilkinson GR, Nutescu EA, Morita T, Ritchie MD, Scordo MG, et al. Different contributions of polymorphisms in VKORC1 and CYP2C9 to intra- and inter-population differences in maintenance dose of warfarin in Japanese, Caucasians and African-Americans. Pharmacogenetics and Genomics. 2006;16(2):101-10. DOI: http://dx.doi.org/10.1097/01.fpc. 0000184955.08453.a8.
4. Korabecny J, Soukup O. Cholinesterase Research. Biomolecules. 2021;11(8):1121. DOI: http://dx.doi.org/10.3390/biom11081121.
5. Mårtensson J, Martling CR, Bell M. Novel biomarkers of acute kidney injury and failure: clinical applicability. British Journal of Anaesthesia. 2012;109(6):843-50. DOI: http://dx.doi.org/10.1093/bja/aes357.
6. Rehn M, Chew MS, Kalliomaki M, Olkkola KT, Sigurðsson MI, Møller MH. ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiologica Scandinavica. 2024;68(9):1179-81. DOI: http://dx.doi.org/10.1111/aas. 14472.
7. Mallick A, Januzzi JL. Biomarkers in Acute Heart Failure. Revista Española de Cardiología (English Edition). 2015;68(6):514-25. DOI: http://dx.doi.org/ 10.1016/j.rec.2015.02.009.
8. Méndez Hernández R, Ramasco Rueda F. Biomarkers as Prognostic Predictors and Therapeutic Guide in Critically Ill Patients: Clinical Evidence. Journal of Personalized Medicine. 2023;13(2):333. DOI: http://dx.doi.org/10.3390/jpm13020333.
9. Rodseth RN, Biccard BM, Le Manach Y, Sessler DI, Lurati Buse GA, Thabane L, et al. The Prognostic Value of Pre-Operative and Post-Operative B-Type Natriuretic Peptides in Patients Undergoing Noncardiac Surgery. Journal of the American College of Cardiology. 2014;63(2):170-80. DOI: http://dx.doi.org/10.1016/j.jacc.2013.08.1630.
10. Stienen S, Salah K, Moons AH, Bakx AL, van Pol P, Kortz RAM, et al. NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide)-Guided Therapy in Acute Decompensated Heart Failure. Circulation. 2018;137(16):1671-83. DOI: http://dx.doi.org/10.1161/circulationaha.117.029882.
11. Álvarez Zurro C, Planas Roca A, Alday Muñoz E, Vega Piris L, Ramasco Rueda F, Méndez Hernández R. High levels of preoperative and postoperative N terminal B-type natriuretic propeptide influence mortality and cardiovascular complications after noncardiac surgery. European Journal of Anaesthesiology. 2016;33(6):444-9. DOI: http://dx.doi.org/10. 1097/eja.0000000000000419.
12. Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Canadian Journal of Cardiology. 2017;33(1):17-32. DOI: http://dx.doi.org/10.1016/j.cjca.2016.09.008.
13. Carpenter CR, Keim SM, Worster A, Rosen P. Brain Natriuretic Peptide in the Evaluation of Emergency Department Dyspnea: Is There a Role? The Journal of Emergency Medicine. 2012;42(2):197-205. DOI: http://dx.doi. org/10.1016/j.jemermed.2011.07.014.
14. Januzzi JL, Chen-Tournoux AA, Christenson RH, Doros G, Hollander JE, Levy PD, et al. N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department. Journal of the American College of Cardiology. 2018;71(11):1191-200. DOI: http://dx.doi.org/10.1016/j. jacc.2018.01.021.
15. Koratala A, Kazory A. Natriuretic Peptides as Biomarkers for Congestive States: The Cardiorenal Divergence. Disease Markers. 2017;2017:1-9. DOI: http://dx.doi.org/10.1155/2017/1454986.
16. L’Heureux M, Sternberg M, Brath L, Turlington J, Kashiouris MG. Sepsis-Induced Cardiomyopathy: a Comprehensive Review. Current Cardiology Reports. 2020;22(5):35. DOI: http://dx.doi.org/10.1007/s11886-020-01277-2.
17. Malbrain MLNG, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Annals of Intensive Care. 2018;8(1):66. DOI: http://dx.doi.org/10.1186/s13613-018-0402-x.
18. Pandompatam G, Kashani K, Vallabhajosyula S. The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock. Revista Brasileira de Terapia Intensiva. 2019;31(3):368-378. DOI: http://dx.doi.org/10.5935/0103-507x.20190060.
19. Vallabhajosyula S, Wang Z, Murad MH, Vallabhajosyula S, Sundaragiri PR, Kashani K, et al. Natriuretic Peptides to Predict Short-Term Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2020;4(1):50-64. DOI: http://dx.doi.org/10.1016/j.mayocpiqo.2019.10.008.

Publication of the article:

«Bulletin of problems biology and medicine», 2024 Issue 4, 175, 381-388 pages, index UDC 340.624.6:577.1

DOI:

10.29254/2077-4214-2024-4-175-381-388