We read with great interest the article by Carlo Custodero et al. recently published in Critical Care [1]. The authors concluded that NT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors. However, the article overlooks the association of NT-proBNP and renal function in septic patients. Studies have shown that acute kidney injury is a common complication of sepsis and is significantly associated with mortality [2, 3], whereas the studies by Gergei et al. [4] and Roberts et al. [5] indicated that NT-proBNP plasma level has shown an exponential increase with declining glomerular filtration rate. Thus, it did not seem persuasive that NT-proBNP could completely predict outcomes without adjusting for the covariate of renal function. We suggest the relationship of the NT-proBNP levels during the acute phase of sepsis and physical function and muscle strength outcomes in sepsis survivors be stratified based on the renal function.
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References
Custodero C, Wu Q, Ghita GL, Anton SD, Brakenridge SC, Brumback BA, et al. Prognostic value of NT-proBNP levels in the acute phase of sepsis on lower long-term physical function and muscle strength in sepsis survivors. Crit Care. 2019;23(1):230.
Ma S, Evans RG, Iguchi N, Tare M, Parkington HC, Bellomo R, et al. Sepsis-induced acute kidney injury: a disease of the microcirculation. Microcirculation. 2019;26(2):e12483.
Kellum JA, Wen X, de Caestecker MP, Hukriede NA. Sepsis-Associated Acute Kidney Injury: A Problem Deserving of New Solutions. Nephron. 2019:1–5. https://doi.org/10.1159/000500167.
Gergei I, Kramer BK, Scharnagl H, Stojakovic T, Marz W. Renal function, N-terminal pro-B-type natriuretic peptide, propeptide big-endothelin and patients with heart failure and preserved ejection fraction. Peptides. 2019;111:112–7.
Roberts MA, Srivastava PM, Hare DL, Ierino FL. Effect of haemodialysis and residual renal function on serum levels of galectin-3, B-type natriuretic peptides and cardiac troponin T. Nephrology. 2018;23(12):1131–8.
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JRY and XTX designed the paper. QRL edited the English text of a draft of this manuscript. All authors participated in the drafting and reviewing. All authors read and approved the final version of the manuscript.
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Ye, J., Liang, Q. & Xi, X. NT-proBNP levels might predict outcomes in severe sepsis, but renal function cannot be ignored. Crit Care 23, 341 (2019). https://doi.org/10.1186/s13054-019-2615-2
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DOI: https://doi.org/10.1186/s13054-019-2615-2