|St. Louis City Hospital|
Are you using biomarkers for all they're worth in your hospitalized patients? Here's a summary of new developments this year.
Procalcitonin has been validated for several roles in guiding the use of antimicrobial therapy, and stands poised to bring the concept of antibiotic stewardship to a new level. The major barrier is its lack of availability in real time in many hospitals. It has recently been approved for use in the US. I linked to a paper reviewing today's use of procalcitonin, here.
BNP and pro-BNP
The precise role of natriuretic peptides in guiding heart failure management remains a subject of controversy. But the most interesting developments this year were in the area of expanded uses of natriuretic peptide measurement outside the management of heart failure. Perhaps the best known of these is risk assessment in patients with pulmonary embolism, discussed in several papers this year and in previous years.
Two new papers were of special interest this year. One looked at the kinetics of pro-BNP in acute onset atrial fibrillation. In cases where the time of onset of a-fib is unclear measurement of pro-BNP may help. Another paper, which I discussed here, reported preliminary evidence that the use of pro-BNP combined with a clinical risk assessment tool in patients presenting with chest pain produced outcomes equivalent to the conventional strategy of “rule out” followed by stress testing.
The role of lactate measurement to assess septic patients' candidacy for early goal directed therapy was validated several years ago. This year produced new information on expanded indications for lactate, particularly the measurement of serial levels in critically ill patients. Two papers addressed this issue, which I linked and summarized here.