Abstract
BackgroundSepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There is a need to identify biomarkers that can predict long-term worsening of physical function to be able to act early and prevent mobility loss. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-accepted biomarker of cardiac overload, but it has also been shown to be associated with long-term physical function decline. We explored whether NT-proBNP blood levels in the acute phase of sepsis are associated with physical function and muscle strength impairment at 6 and 12 months after sepsis onset.MethodsThis is a retrospective analysis conducted in 196 sepsis patients (aged 18–86 years old) as part of the University of Florida (UF) Sepsis and Critical Illness Research Center (SCIRC) who consented to participate in the 12-month follow-up study. NT-proBNP was measured at 24 h after sepsis onset. Patients were followed to determine physical function by short physical performance battery (SPPB) test score (scale 0 to12—higher score corresponds with better physical function) and upper limb muscle strength by hand grip strength test (kilograms) at 6 and 12 months. We used a multivariate linear regression model to test an association between NT-proBNP levels, SPPB, and hand grip strength scores. Missing follow-up data or absence due to death was accounted for by using inverse probability weighting based on concurrent health performance status scores. Statistical significance was set at p ≤ 0.05.ResultsAfter adjusting for covariates (age, gender, race, Charlson comorbidity index, APACHE II score, and presence of CCI condition), higher levels of NT-proBNP at 24 h after sepsis onset were associated with lower SPPB scores at 12 months (p < 0.05) and lower hand grip strength at 6-month (p < 0.001) and 12-month follow-up (p < 0.05).ConclusionsNT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors.
Highlights
Sepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality
We analyzed a subsample of 196 consecutive sepsis patients who consented to participate in the 12-month follow-up study and who had 24-h NT-proBNP levels
Over 39 months ending April 2018, 224 patients were enrolled in the Sepsis and Critical Illness Research Center (SCIRC) sepsis database
Summary
Sepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There have been advances in early diagnosis and treatment with a significant reduction of in-hospital mortality, many survivors develop chronic critical illness (CCI) and the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term organ dysfunction, chronic inflammation, functional limitations, and higher mortality [2, 3]. Studies have shown that progressive decline in physical function after critical illness, such as sepsis, leads to disability, dependence on caregivers, and higher long-term mortality [4,5,6]. Identification of acute-phase biomarkers associated with poor long-term physical function in sepsis survivors could serve as an indicator for early implementation of strategies to prevent functional decline and disability. Cardiovascular dysfunction in the acute phase of sepsis may be indicative of long-term physical dysfunction
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