N末端前B型利钠肽对严重感染及感染性休克患者预后的预测作用

目的 评价N末端前B型利钠肽(NT-proBNP)对严重感染及感染性休克患者预后的预测作用.方法 采用前瞻性研究方法,收集并观察50例严重感染及感染性休克患者的临床资料.于入重症监护病房(ICU)0、24、48、72 h测定血浆NT-proBNP水平,根据住院30 d死亡情况分为死亡组与存活组并进行比较.用受试者工作特征曲线(ROC曲线)评价血浆NT-proBNP水平对死亡的预测作用;采用线性回归分析评价血浆NT-proBNP的干扰因素.结果 死亡组(20例)血浆NT-proBNP水平(μg/L)在入ICU 0 h20.86(14.28,23.92)]时明显高于存活组30例,10.02(5.58,16.41),P＜0.01],且这种差异持续至72 h19.68(13.90,24.02)比9.24(4.30,11.81),P＜0.01],但组内各时间点之间比较均无明显差异;ROC曲线下面积(AUC)为0.842,95%可信区间(95%CI)为0.764～0.922,P＜0.01.以入ICU时血浆NT-proBNP水平＞13.30μg/L作为判断死亡的最佳临界值,其敏感性为80.6%,特异性为70.2%.线性回归分析发现,氧合指数(PaO2/FiO2,r=-0.839,P=0.003)、血小板计数(PLT,r=-0.803,P=0.032)和入ICU 0 h时感染相关器官功能衰竭评分(SOFA,r=0.874,P＜0.001)是NT-proBNP的独立相关因素.结论 血浆NT-proBNP水平可以预测严重感染及感染性休克患者的预后.

The prognostic value of N-terminal pro-B-type natriuretic peptide in patients with severe sepsis and septic shock

Objective To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with severe sepsis and septic shock. Methods In a prospective study, clinical data of 50 patients with severe sepsis and septic shock were analyzed. Plasma NT-proBNP level was measured at 0, 24, 48 and 72 hours after admission to the intensive care unit (ICU) of a university hospital. Patients were divided into survival group and non-survival group according to 30-day mortality rate. The dynamic variation of plasma NT-proBNP level was observed and the difference of plasma NT-proBNP levels between two groups was compared. The predictive value of NT-proBNP on mortality was evaluated by receiver operating characteristic (ROC) curves. The potential confounding factors on NT-proBNP were assessed with linear regression analysis. Results NT-proBNP levels (μg/L)at 0 hour after admission to ICU20. 86(14. 28, 23.92)]were significantly higher in non-survival group (n = 20) compared with survival group n=30, 10. 02 (5.58, 16.41), P＜0. 01], and the difference persisted to 72 hours19. 68 (13. 90, 24.02)vs. 9. 24 (4. 30, 11.81), P＜0. 01], but there was no statistical difference of NT-proBNP levels among four time points. In the ROC curves for NT-proBNP at admission, the area under the curve (AUC) for hospital mortality was 0. 842, and 95% confidence interval (CI) was 0. 764 - 0. 922, P＜0. 01. NT-proBNP greater than 13. 30 μg/L at admission was an independent indicator of mortality (sensitivity 80. 6%, specificity 70. 2%). Linear regression analysis revealed that the oxygenation index (PaO2/FiO2, r =- 0. 839, P =0. 003), platelet count (PLT, r=-0. 803, P=-0. 032), and sequential organ failure assessment (SOFA)scores at 0 hour after admission to ICU (r = 0. 874, P＜ 0. 001) had independent effects on NT-proBNP values at admission. Conclusion Plasma NT-proBNP level is a valuable prognostic factor for severe sepsis and septic shock patients.