Dynamic Changes in Circulating Plasma B-type Natriuretic peptide levels and its Influencing Factors in Patients with Hemorrhagic Fever with Renal Syndrome

Background: Typically, Hemorrhagic fever with renal syndrome (HFRS) occurs in five sequential stages: Febrile, hypotensive, oliguric, polyuria, and convalescent stage. The pathophysiological process involves the release of inflammatory mediators, the fluctuation of blood volume and the injury of the Multiple organs, and all the factors mentioned above may cause the elevation of the level of plasma B-type natriuretic peptide (BNP). In addition, the physiological effects of BNP in regulating blood volume and promoting angiogenesis may in theory alleviate the pathological state of HFRS. So, this study is to explore the clinical application of BNP in HFRS by dynamically monitoring the BNP levels and analyzing the factors associated with BNP expression.Methods: Eighty-six in-patients with HFRS were divided into the mild, moderate and severe groups according to disease severity. Mixed-effects linear model was used to analyze the differences in BNP expression according to disease severity and disease stage. The factors affecting BNP expression were analyzed using a linear regression model for each disease stage.Results: BNP showed dynamic changes that corresponded with disease progression. The more severe the disease, the overall BNP level was higher. Disease severity, neutrophil count and pulse pressure were independent factors for BNP, while cardiac injury related indicators were not.Conclusions: In HFRS the main factors promoting BNP expression were inflammation and blood volume, rather than heart disease. BNP can be regarded as an index for judging the severity of the disease and guiding body fluid treatment.