As sepsis syndrome evolves and the patient’s condition continues to deteriorate, several mechanisms may be involved in BNP elevation, such as proinflammatory cytokine oversecretion [8,12-14], ensuing systolic and diastolic biventricular dysfunction [9,10,31], altered BNP clearance [16], renal failure [32] and sepsis-associated acute lung injury or acute respiratory distress syndrome [18]. Here, NPPB is linked to acute respiratory distress syndrome.