| Background and objective: Sepsis is a common disease, and high cause ofdeath in pediatric intensive care unit. Myocardial injury is a well-known complicationof sepsis. Early identification of septic patients with myocardial injury and septicpatients at high risk of dying remains a challenge. And more clinical evidence isneeded to predicted septic patients. In recent years, the research that sepsis canstimulate the secretion of NT-proBNP from myocardium is paid wildly attention. Weare aim to detect the clinical diagnostic value of NT-proBNP in septic children withmyocardial damage, and discuss the prognostic value of NT-proBNP in patients withsepsis.Methods:162consecutive PICU admissions during the study period of Jan1st,2013to June30,2013at Hunan Children’s Hospital were enrolled in the study.Patients with congenital heart disease, heart failure, cardiomyopathy, myocarditis,chronic cardiac insufficiency, chronic renal insufficiency were excluded. The162septic patient were divided into myocardical injurr group and non-myocardical injurygroup,sepsis group and severe sepsis group,sepsis group and septic shockgroup,survival group and death group. according to Keyur B’s method,we dividedNT-proBNP values into tertiles. According to clinical registration form designed byourselves, the clinical dates were collected systematically and prospectively. NT-proBNP was tested in the first and third day after162septic patients in hospital(NT-proBNP1,NT-proBNP3). lactate dehydrogenase(LDH), creatine kinase isoenzyme(CK-MB), troponin I(cTnI), myoglobin and so on were measured in24h afteradmission, PCIS score was assessed in all patients. Compare NT-proBNP level ofgroups, summarize the change of NT-proBNP in groups, analysis the relationshipbetween NT-proBNP and PCIS,CK-MB.Results1. The levels of NT-proBNP1of sepsis group was significantly higher than the controlgroup(P=0.000). there was significant difference among the control group,myocardialinjury group and non-myocardial injury group(P=0.000). The NT-proBNP level inmyocardial injury group is higher than the non-myocardial injury group(P=0.000). NT-proBNP1、CK-MB、cTnI、myoglobin are the date of abnormal distributions,we use log transformation to make them be normal distribution. log(NT-proBNP) wascorrelated with logCK-MB,logcTnI and logMB. The ability of NT-proBNP to detectmyocardial injury was assessed by using receibver operation characteristiccurve(ROC) analysis. The area under the curve(AUC) for the ROC curve for identifymyocardial injury was0.79,95%CI0.605to0.807,P=0.000, NT-proBNP value of1163ng/ml had a sensitivity of70.8%and a specificity of66.2%.2. According to the research of Keyur B[1], we divided NT-proBNP level into tertiles.They are group1, group2and group3. The lactic acid, BUN,ALT,CK-MB, cTnI,myoglobin and PCIS was different among the three groups(P<0.05). There wasdifference in the incidence of inpaired immunity, hepatic injury, coagulation disordersamong the three groups(P<0.05). The incidence of myocardial damage (P=0.000),severe sepsis(P=0.005) and the use of mechanical ventilation(P=0.006) andvasopressors(P=0.001) were different among the three groups. NT-proBNP wasdifferent among the three groups. logNT-proBNP1is negatively related to thelogPCIS(r=-0.44，P=0.000).3. Plasma NT-proBNP level in severe sepsis group and septic shock group werehigher than sepsis group, the PCIS in the sepsis group is higher than severe sepsisgroup and septic shock group (P<0.05). The AUC for the ROC curve for identifysevere sepsis was0.761,95%CI0.650to0.872，P=0.000, NT-proBNP value of1574pg/ml had a sensitivity of75.9%and a specificity of73.7%. The AUC for theROC curve for identify septic shock was0.735,95%CI0.601to0.868，P=0.03NT-proBNP value of1720pg/ml had a sensitivity of73.3%and a specificity of70.7%.4. There were148survivor(91.36%) and14death(8.64%). NT-proBNP1and PCISwere different between survivor group and death group(P<0.05).NT-proBNP3andNT-proBNP correlated to each other positibely(r=0.698， P=0.000),but was notsignificantly different from each other(P=0.18). in the death group, NT-proBNP3washigher than NT-proBNP1(P=0.037), contrarily, NT-proBNP3was lower than NT-proBNP1in the survivor group(P=0.023). The AUC for the ROC curve for identifydeath was0.758,95%CI0.624to0.891，P=0.001, NT-proBNP value of2332pg/mlhad a sensitivity of71.4%and a specificity of72.3%.Conclusion1.NT-proBNP could be used to help to diagnose sepsis with myocardial damage. 2.NT-proBNP could be used to assess the condition of septic patients,and dynamic testNT-proBNP can help to predict septic patients’ prognosis... |
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