Effectiveness of Atrial Natriuretic Peptide in the Treatment of Critically Ill Patients: A Systematic Review and Meta-Analysis.

Abstract

<b>Background</b>: Atrial natriuretic peptide (ANP) has emerged as a potential therapeutic agent in critical care settings due to its physiological effects on diuresis, natriuresis, and vasodilation. Despite several promising preclinical data, their clinical utility remains controversial, necessitating a comprehensive evaluation of existing evidence. <b>Methods</b>: A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches were performed in PubMed, Google Scholar, and Cochrane databases. Fifteen studies (<i>n</i> = 7187) comparing ANP to placebo in critically ill patients were included. Primary outcomes included mortality, hospital length of stay, ICU length of stay, and serum creatinine level. Risk ratios and mean differences with 95% confidence intervals were calculated using random-effects models. <b>Results</b>: ANP therapy showed no significant impact on mortality (RR 1.03, 95% CI: 0.89-1.19, <i>p</i> = 0.72) but significantly reduced hospital length of stay (MD -1.81 days, 95% CI: -1.91 to -1.72, <i>p</i> < 0.00001). ICU length of stay showed no significant difference between groups in subgroup analysis (MD +0.10 days, 95% CI: -0.03 to 0.23, <i>p</i> = 0.15). Subgroup analysis revealed improved creatinine levels with ANP (MD -0.19, 95% CI: -0.20 to -0.19, <i>p</i> < 0.00001), though high heterogeneity was noted across outcomes. <b>Conclusions</b>: ANP therapy shows promise in shortening hospital stays and enhancing renal function in select patients, but its effectiveness varies widely across clinical settings. Large-scale, multicenter studies are necessary to determine the ideal patient groups for ANP therapy in critical care.