The predictive value of plasma N-terminal pro-B-type natriuretic peptide levels in the evaluation of prognosis and the severity of patients with septic shock induced myocardial suppression

Abstract

To investigate the predictive value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in the evaluation of prognosis and the severity of patients with septic shock induced myocardial suppression. A prospective study was conducted, with enrollment of 102 patients with septic shock in intensive care unit (ICU) of Beijing Shijitan Hospital from August 2009 to August 2011. Plasma NT-pro-BNP levels were measured on the 1st, 3rd and 5th day after admission, and the acute physiology and chronic health evaluationII (APACHEII) score, sequential organ failure assessment (SOFA) score were monitored at admission to ICU. With the 28-day mortality after admission to ICU as the standard, the patients with septic shock were divided into the survivor group and non-survivor group. Dynamic changes in plasma NT-proBNP levels and score of APACHEII and SOFA were compared between two groups. The patients were divided into non-cardiac dysfunction group [cardiac index (CI)>50.0 ml×s(-1)×m(-2)] and cardiac dysfunction group (CI<50.0 ml×s(-1)×m(-2)) according to levels of CI after admission 24 hours. The level of plasma NT-proBNP was compared between two groups. The predictive value of plasma NT-proBNP on 28-day mortality was evaluated by multivariate logistic regression analysis. (1)APACHEII score, SOFA score and plasma NT-proBNP levels in non-survivor group (n=45) were higher than those of survivor group (n=57, 1-day APACHEII score: 23.8±0.6 vs. 14.3±0.3, 1-day SOFA score: 12.4±3.0 vs. 7.7±2.8; NT-proBNP 1 day: 4.13±1.05 μg/L vs. 1.65±0.26 μg/L, 3 days: 5.32±0.93 μg/L vs. 1.87±0.29 μg/L, 5 days: 6.90±1.33 μg/L vs. 1.23±0.19 μg/L, P<0.05 or P<0.01). (2)Plasma NT-proBNP levels in cardiac dysfunction group (n=47) were higher than those of non-cardiac dysfunction group (n=55), and elevated obviously in non-survivors than those in survivors. (3)In multivariate logistic regression analysis, NT-proBNP level and APACHEII score were independent predictors of 28-day mortality (P<0.05 or P<0.01). Plasma NT-proBNP levels show obvious significance in evaluation of prognosis and the severity of patients with septic shock induced myocardial depression. Plasma NT-proBNP level and APACHEII score are independent prognostic markers of mortality and sepsis-induced myocardial depression in septic shock.