Anestéziológia a intenzívna medicína 1/2014

Secretion of adrenomedullin and natriuretic peptide type A after hemorhagic shock in oncological patients

Objective: Human body during hemoragic shock has usually developed strong general neuroendocrinne stress response which target is to overcome critical state by means of general adaptive reaction. Many hormones and humoral substances are released during and after circulatory hemorhagic shock which one target: maintain, save and protect basic vital functions and organs. Special function have adrenomedulin and natriuretic peptides , its secretion and plasmatic concentration have steeply increased during critical situation. Goal of our study is to follow-up the dynamics of concentration of adrenomedullin and natriuretic peptide type A (ANP) in early period after having hemoragic shock. Compare the dynamics of secretion of adrenomedulin among patients who survived or not survived hemorhagic shock. Materials and method: We followed-up plasmatic concentration of two hormones adrenomedulin (ADM) and natriuretic peptide type A (ANP) on the cohort of 4 oncological patients during first three ICU days. Hormones were investigated using radioimmunoassay method by means of KRYPTOR diagnostic device. We correlate our findings with lactate level. We also followed-up morbidity and mortality of patients. Results: From 4 oncosurgical patients 2 patients survived and 2 patients died during early post-shock period. All patients had significantly elevated plasmatic levels of ADM and ANP. Survivors had lower values of investigated hormones: adrenomedullin (1,73-2,61 nmol/l) and natriuretic peptide type A (159-178 ng/ml) than non-survivors , who died on the consequences of severe hemoragic šok: concentration of adrenomedulín (3,47-5,64 ng/ml), ANP (439-817 ng/ml) were higher than in survivors. Conclusion: Adrenomedullin and natriuretic peptide type A are new endocrinne markers of severity of circulatory shock and endocrinne stress. Its validity and reliability should be evaluated in larger and well designed controlled clinical studies.

Keywords: hemorhagic shock, adrenomedullin, natriuretic peptide type A, critical illness.