Clinical Investigation On The Predictive Values Of N-terminal Probrain Natriuretic Peptide For Theseverity And Early Prognosis In The Septic Patients

Objective：To investigate the concentration of the N-terminal pro-brain natriuretic peptide(NT-proBNP) in different severity patients with sepsis, and whether can be used asone of the indicators of sepsis severity, whether can be used as a predictor of earlyprognosis of patients with sepsis, then may be helpful in risk accessment in intensivecare unit.MothedAll cases of sepsis were admintted to our emergency intensive care unit onJanuary1,2008to June30,2013,who was chosen according to the standard ofAmerican college of chest physicians (ACCP)/American society of critical care(SCCM) consensus conference formulated and revised diagnostic criteria in2008.Finally,158cases were included in the study. According to the severity of thecritical condition,all the cases were divided into sepsis group (58), severe sepsis group(77), septic shock (23).The patients’medical records, including its age, gender, pastmedical history, etc were recorded. The NT-proBNP (which was documented in6hours after admitted to hospital and diagnosis of sepsis) and APACHE II score, SOFAscore, Marshall score, troponin (cTnI), arterial blood lactate index (Lactic Acid),c-reactive protein (CRP), calcitonin (PCT) were documented and analysised.The NT-proBNP was comparedwith various indicators at28d death which is chosen as thecutoff point.Result1. NT-proBNP were comparied among the three groups, because of the NT-proBNP values were skewed distribution, nonparametric method (Kruskal Wallismethod) independent sample test was used to analysis. The result showed that thedifferences of NT-proBNP among the three groups was significant.(p<0.001).NT-proBNP elevated along with the severity of the patints.2.The correlation analysis of NT-proBNP and otherseverity score was meaningful.APACHE II rank correlation analysis results showed rs=0.662,(p<0.01); and SOFAindicators rank correlation analysis showed the rs=0.445,(p<0.01); with Marshallindex correlation analysis showed rs=0.291,(p<0.01); Results: the relationshipamong NT-proBNP and APACHE II score, SOFA score, Marshall score was positivelycorrelated.3.The correlationanalysis of NT-proBNP and age、cTnI、arterial blood lacticacid、 inflammatory factorswas also significant. Age related analysis results for the rs=0.398,(p<0.01); CRP indicators rank correlation analysis, the results for the rs=0.169,(p<0.05); with PCT index correlation analysis, the result for the rs=0.278,(p<0.01); arterial blood lactate index correlation analysis, the result for the rs=0.472,(p<0.01);andcTnI index correlation analysis, the result for the rs=0.328,(p<0.01).Result: the relationgship among NT-proBNP and age, cTnI, arterial blood lactic acidcorrelated、inflammatory indexes was positively correlated.4. NT-proBNP between the death group and the survival group was different(p<0.05). NT-proBNP of patients in survival group focused on the0～2500pg/mL,which death group focused on8000～9000pg/mL, the differences between the twogroups was obvious.Combined with the data which could be concluded that NT-proBNP of the death group was higher than the survival group.Conclusions1. The degree of NT-proBNP was different in patients with sepsis and it showeda progressive increase.2.NT-proBNP positively correlated with inflammatory indexes, cTnI, arterialblood lactic acid, age and other severity score of patients with sepsis.3.The NT-proBNP of patients in death group was higher than the survival group.4. NT-proBNP, age, PCT, arterial blood lactic acid positively correlated with28d mortality in patients with sepsis.