Prognostic value of Amino Terminal Pro B-type Natriuretic Peptide (NT-proBNP) in patient with severe sepsis and septic shock in an ICU of tertiary care hospital of Bangladesh.

Abstract

Background: Severe sepsis and septic shock are the leading cause of ICU admission. Despite the adequate resuscitation, septic shock is frequently associated with multiple system organ failure (MSOF) and death. This study examined the clinical utility of the level of NT-proBNP as an indicator of outcome in severe sepsis and septic shock.Objectives: to find relationship between level of NT-Pro-BNP and the outcome of the patients of severe sepsis and septic shock.Design: This Prospective observational study done in ICU of BIRDEM General Hospital.Method: All consecutive patients who were diagnosed as severe sepsis and septic shock according to SSC (Surviving Sepsis Campaign) guidelines fulfilling the selection criteria were included in the study. Informed written consent was taken from patient’s first degree relatives. Just after admission of severe sepsis and septic shock patients into ICU and development of severe sepsis or septic shock of previously admitted ICU patients, blood sample for serum NT-proBNP level was sent to hospital laboratory. 28 days were taken as follow up period for all patients in this study. Outcome was measured by mortality. Those who were discharged or transferred were classified as survivors and those who were died, categorized as non survivors. Those who were neither discharged nor dead during the study period were classified as survivors. Patient’s resusci-tation and management were done according to the standard ICU protocol of BIRDEM General Hospital.Result: A total 127 of patients fulfilled the criteria of sepsis and septic shock and study inclusion criteria during the study period. The mean & SD of age in this study was 63.69 ± 17.79 years. 52% (n = 66) were male & 48% (n = 61) were female. Here DM was the most common (83.5%) comorbidity and predominant diagnoses were Pneumonia (58.3%) & UTI (30.7%). Among 127 patients, 24.4% (n=31) were in septic shock and 75.6% (n= 96) patients present with severe sepsis. Level of NT-proBNP of severe sepsis patients were 4608.64 ± 7712.12 & Level of NT-proBNP of septic shock patients were 19239.06 ± 13058.05 (P<0.0001). Among 31 (24.4%) septic shock patients, 32.2% (n=10) patients were survivor and NT-proBNP level was 7333.50 ± 10624 pg/ml; 67.8% (n=21) patients were non survivor and NT-proBNP level was 24908.38 ± 10017.87 pg/ml (P <0.001). In this study among 96 (75.6%) patients with severe sepsis, 88.7% (n=86) were survivor and NT-proBNP level was 2436.41 ± 3755.03 pg/ml; 11.3% (n=11) patients were non-survivors and NT-proBNP level was 21238.36 ± 10095.34 pg/ml (P<0.0001).Conclusion: Severe sepsis and septic shock are the leading cause of ICU admission and also leading cause of death. Our study showed that, elderly with diabetes mellitus had developed more sepsis. Pneumonia and UTI are commonest cause of sepsis.Sepsis causes extreme inflammatory reactions involving all organs of whole body including heart, causing release of NT-proBNP. Raised level of this biomarker associated with increased rate of mortality.Bangladesh Crit Care J September 2018; 6(2): 65-70