Determination of the dynamics of natriuretic peptide in response to volume load in patients with acute surgical pathology of the abdominal cavity

Abstract

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 intraabdominal 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.