Clinical Study Of Change Of NT-proBNP And Its Significance In Severe Trauma Patients

Background:N-terminal pro-B-type natriuretic peptide (NT-proBNP) is now widely used in dfferential diagnosis for dyspnea, diagnosis and prognosis for heart failure and as a useful marker reflecting therapeutic effect, but its expression and significance in severe trauma patients is not clearly known.Objective:To investigate the dynamic change of NT-proBNP in severe trauma patients, explore the factors which may influence NT-proBNP, and then evaluate its clinical significance.Methods:It was a prospective observation study.50 severe trauma patients treated in emergency intensive care unit (EICU) were enrolled. NT-proBNP, acute physiology and chronic health evaluation (APACHE)Ⅱ, the Glasgow coma score (GCS), creatine kinase-MB (CK-MB), cardiac troponinⅠ(cTnI), procalcitonin (PCT) were detected at 1 st,3rd,7th day after trauma. The central venous pressure (CVP) was recorded at 1 st and 3rd day, and the volume changing during the 1st to 3rd day was also recorded. The injury severity score (ISS) were recorded at admission.We described the change of NT-proBNP level of all the patients enrolled, then a nalyzed the change of NT-proBNP in groups of different prognosis and different ISS level respectively. The values of NT-proBNP to judge prognosis and were analyzed. The difference of NT-proBNP between with brain trauma and without brain trauma, normal PCT level and abnormal PCT level were also analyzed. We analyzed the relationships between NT-proBNP and the central venous pressure, so were their changes. The relationships between NT-proBNP changes and volume changes during 1st to 3rd day were analyzed, too. The relationships between NT-proBNP and GCS, CK-MB, cTnI were analyzed respectively. Gradually linear regression analysis was used to choose the significant correlated markers with NT-proBNP at different time point.Results:There were no significant changes of NT-proBNP in all patients. NT-proBNP in Non-survivors was significantly higher than the survivors at all the time points. And the NT-proBNP at 7th day was significantly higher than the NT-proBNP at 1st day in Non-survivors. NT-proBNP level of survivors at 7th day was lower than NT-proBNP level at 1st and 3rd day. The level of NT-proBNP in the ISS≥25 group was higher than the ISS< 25 group in all the time points, NT-proBNP did not change significantly in the ISS≥25 group. But in the ISS< 25 group, NT-proBNP level decreased at 7th day contrast to the 3rd day. The change of NT-proBNP significantly correlated with the change of the CVP and the change of volume. There were no different NT-proBNP levels between the group with brain trauma and without bain trauma at all of the time points. At the 3rd and 7th day, the group of abnormal PCT had a higher level of NT-proBNP than the group of normal PCT level. CK-MB, cTnI were both had a little relationgship with NT-proBNP at all time points. Conclusion:A significantly high level of NT-proBNP at admission or NT-proBNP level without decreasing in several days after severe trauma might show poor outcome. NT-proBNP may be useful to judge the outcome and reflect pathogenetic condition for severe trauma patients. Dynamic changing of NT-proBNP level may reflect body blood volume changing. Use NT-proBNP together with other index reflecting blood volume, we can get the blood volume imformation. NT-proBNP level may be influenced by cardiac muscle injury and sepsis. There were no different NT-proBNP levels between the group with brain trauma and without bain trauma. NT-proBNP might be an effective marker in athogenetic condition monitoring and prognosis for severe trauma patients.