| Objective:Sepsis (Sepsis) is a severe trauma, extensive burns, shock, severe infection, severe clinical complications of acute and severe patients and also is a systemic inflammatory response syndrome (SIRS) with infection. The incidence and development of sepsis has closely relationship with infection, inflammation, immune and blood coagulation system function. Sepsis, rapid progression, high mortality, treatment costs staggering.Early Prediction of the occurrence of sepsis development, implemen-tation of early intervention is the key to reduce morbidity and mortality of sepsis. there are many aspects of clinical research about early detection and prognosis of sepsis. Currently, the widespread use of early warning indicators in sepsis are serum procalcitonin (PCT), C-reactive protein (CRP) and protein C (PC)/activated protein C (APC), etc. Serum NT-proBNP is widely used indicators in the field of cardiovascular disease. As people on serum NT-proBNP-depth knowledge, more and more people use it for research sepsis. This article by dynamic observation of serum NT-proBNP in patients with sepsis, To assess the significance of NT-proBNP in sepsis.Methods:1. We chose in May 2009～December 2009 admitted to the emergency, First Affiliated Hospital of Dalian Medical University and medical intensive care unit (ICU) patients 47 cases of sepsis study.47 cases of sepsis were further divided into Non-severe sepsis group (25 cases), severe sepsis/septic shock group (22 cases),28 days according to whether the death is divided into the survival group (27 cases) and death group (20 cases), and select patients with common infections (18 cases) and healthy group of people (17 cases) for comparison.2 We use Roche proBNP kit, use electric Chemiluminescence Method on Roche Elecsys automatic biochemical analyzer.Subjects in each group were measured at admission,12 hours of admission, admission 24 hours,72 hours of admission serum NT-proBNP levels. While the same time dynamic observation of serum PCT levels, CRP levels, and measured on admission, admission fifth day of left ventricular ejection fraction (LVEF) and the Evaluation of Acute Physiology and Chronic Health Evaluation (APACHEⅡscore).Results:1. The levels of serum NT-proBNP levels showed a normal distribution. (47 cases) in patients with sepsis, (18 cases)general infection patients and (17 cases)healthy population of blood on admission NT-proBNP levels were compared. We found that patients with sepsis that serum NT-proBNP levels were significantly higher than the other two groups, the difference was significant (F admission= 53.068, P<0.01). We also found that patients with sepsis and infection in patients and normal healthy people are generally the time of admission inflammatory markers (PCT, CRP) and Acute Physiology and Chronic Health Evaluation (APACHEⅡscore) compared to patients with sepsis, PCT, serum CRP, and APACHEⅡscore was significantly increased, the difference was significant (F serum PCT= 68.046, F serum CRP= 57.031, FAPACHEⅡscore= 281.643, P<0.05).2. Using Pearson correlation analysis, we have all 82 cases of observed objects admission serum NT-proBNP levels and serum PCT levels, serum CRP levels, APACHEⅡscore to do correlation analysis, we found that serum NT-proBNP levels and serum PCT level was positively correlated (r Serum PCT= 0.956, P<0.05);serum NT-proBNP levels and serum CRP level was positively correlated (r Serum CRP= 0.926, P<0.05); serum NT-proBNP levels and APACHEⅡscore was positively correlated (rAPACHEⅡscore= 0.87, P<0.05).3. Dunnett T3 method used to do pairwise comparison analysis of variance, we found that the serum NT-proBNP level in (22 cases)severe sepsis/septic shock group is higher than in patients (25 cases) Non-severe sepsis, the difference statistically significant (P<0.01). General infected patients and healthy persons serum NT-proBNP levels, the difference was not significant (P> 0.05).4. Comparison of two-sample t-test analysis, we found that the death group and survival in septic patients at different time points compared detection of serum NT-proBNP levels are different, in the death group were higher than the survival group, the difference was statistically significant (t入院时=3.761,t入院12h=4.924, t入院24h=4.81,t入院72h=5.129, P all<0.01); different time detection of serum PCT levels between the death group was higher than the survival group, the difference was statistically significant (t入院时=3.372,t入院12h=3.357,t入院24h=3.649, t入院72h=4.196, P all<0.01); different time detection of serum CRP levels between the death group was higher than the survival group, the difference was statistically significant (t入院时=3.273, t入院12h=3.357, t入院24h=3.649,t入院72h=4.196, P all<0.01); Admission APACHEⅡscore in the death group was higher than the survival group, the difference was statistically significant (t入院时=3.369,P<0.01), while the hospital five days after the review LVEF≤40% survival rate compared with no significant difference (X2= 0.215, P> 0.05).5. ICU mortality in septic patients further on-line multivariate logistic analysis, the results showed that:in theAge, Sex, SerumPCT, SerumCPR, APACHEⅡscore and admission, hospitalization for 12 hours, admission 24 hours,72 hours of admission NT-proBNP levels of various factors on death have a significant effect of the variable is 72 hours of admission NT-proBNP levels, PCT, APACHEⅡscore; P values were PNT-proBNP= 0.038, P PCT= 0.043, P APACHEⅡscore= 0.047.6. Serum NT-proBNP levels in patients with sepsis 28-day mortality ROC curve analysis:admission, admission 12-hour,24-hour hospital admission 72 hours each time point of the area under the ROC curve and the confidence intervals (admission Area:0.802 95% confidence interval 0.678-0.926, an area of hospitalized 12 hours:0.837 95% confidence interval 0.723-0.951, admission 24-hour area:0.839 95% confidence interval 0.726-0.951, an area of hospitalized 72 hours:0.898 95% confidence interval 0.814-0.982, P all<0.01) time points according to the area under the curve of serum NT-proBNP reached 28 days of diagnosis of sepsis, the higher the accuracy of the death, can be used to assess the prognosis of patients with sepsis; 72 hours of admission to analysis of serum NT-proBNP 28-day mortality of sepsis diagnosis ROC area under the curve maximum (0.898), indicating that 72 hours of admission serum NT-proBNP levels to predict death within 28 days of sepsis, independent of the very significant serological markers. Further analysis of the best of serum NT-proBNP diagnostic threshold value (cut-off point) is:72 hours of admission serum NT-proBNP 2040.2 pg/ml, the diagnosis of sepsis, sensitivity of 28-day mortality (95%), specificity degree (70.4%). Conclusion:In conclusion, serum NT-proBNP in septic patients than normal water, and healthy people infected group was significantly higher, probably due to severe infection and the presence of multiple organ dysfunction caused. Serum NT-proBNP and serum PCT, CPR levels and APACHEⅡscore was positively correlated with serum NT-proBNP levels help to assess the severity of sepsis and the prognosis, compared to APACHEⅡdata collection difficult score and other prognostic indicators NT-proBNP test is quick, simple features, NT-proBNP in the assessment of the possible severity of sepsis and the risk of death in patients are significant, NT-proBNP may be a new clinical assessment tools, but there are still many problems to be studied, more forward-looking, rational design, large sample study has confirmed.
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