| Objective:To clarify the Prognosis value of B-type natriuretic peptide (BNP) in combination with plasma neutrophil gelatinase associated lipocalin (NGAL) for the prognosis of patients with severe sepsis.Methods:A single-center prospective observational method was adopted in this study. Patients who meet the inclusion had been hospitalized in department of dritical care medicine Zhongda Hospital, Southeast University from July 2015 to February 2016 were enrolled. The general characteristics including age, body weight index, gender, underlying disease, infection source, APACHE ? score, SOFA score of the patient were recorded. The enrolled day is defined as Dl, and the serum BNP and NGAL levels were measured by immumofluorescence method on D1, D2 and D7. During a 28-day period, the mortality, days of mechanical ventilation, vasoactive drugs usage, CRRT and hospital stays in ICU were recorded. (1) According to the survival condition during 28 days, the survival group and the non-survival group were divided to compare the difference on general condition, BNP and NGAL of the patient within/among two groups. (2) Cox proportional hazard model was used to make multivariate survival analysis, and according to whether the level of combination of BNP and NGAL of the patient was larger than normal values, patients were divided into 4 groups, including the first group (BNP?100pg/ml and NGAL?153pg/ml (low BNP/low NGAL), the second group (BNP>100pg/ml and NGAL?153pg/ml (high BNP/low NGAL), the third group (BNP?100pg/mI and NGAL>153pg/ml (low BNP/high NGAL) and the fourth group (BNP>100pg/ml and NGAL>153pg/ml (high BNP/high NGAL). Kaplan-Meier Method was used for calculating the survival rate and drawing the survival curve; log-rank was used for testing the difference among groups, and the predictive value of different levels of combination of BNP and NGAL on D1, D2 and D7 to the death of severe sepsis patients during a 28-day period was respectively evaluated. (3) The area under the receiver operating characteristic curve was used for evaluating the predictive valves of individual and combined BNP and NGAL on D1, D2 and D7 to the death during a 28-day period, and the comparison on value of death predicted of BNP, NGAL, combination of BNP and NGAL of the patient was made.Result:Two hundred thirty-two patients with severe sepsis were screened,124 patients with severe sepsis were enrolled finally. Among these patients,86 patients survived and 42 patients died, with the 28 day mortality of 33.9%.1. Patients' characteristicsThere were no statistical differences (P>0.05) in regards to age, body weight index, gender, underlying disease and infection source of patients in the survival group and the non-survival group at the time of enrolling the group. Compared with the survival group, the APACHE ? score and SOFA score of patients in the non-survival group at the time of enrolling the group are all relatively high (P<0.05).2. Dynamic change of BNP and NGAL of patients in the survival group and the non-survival group(1) Dynamic change of BNP of patients in survival group and death group:compared with D1, the level of BNP of the patient in survival group was significantly increased on D2[173.0 pg/ml (72.5-465.0) vs.261.0 pg/ml(132.0-572.0),P<0.05], the level of BNP of the patient in survival group was significantly decreased on D7[173.0 pg/ml (72.5-465.0) vs. 111.0 pg/ml(37.0-314.0), P<0.05], while the level of BNP was aslo significantly decreasd on D7 compared with D2[261.0 pg/ml (132.0-572.0) vs.111.0 pg/ml(37.0-314.0), P<0.05]; Compared with D1, the level of BNP of the patient in the non-survival group has upward trend on D2[313.5 pg/ml (130.0-729.0) vs.385.5 pg/ml(183.0-1490.0), P=0.787], while the level of BNP of that was significantly increased on D7 compared with D1 and D2[313.5 pg/ml (130.0-729.0),385.5 pg/ml(183.0-1490.0)vs.470.5 pg/ml (161.0-679.0), P<0.05]. Compared with the survival group, the level of BNP of the death group was significantly increased on D1, D2 and D7 (P<0.05).(2) Dynamic change of NGAL of patients in survival group and death group:compared with D1, the level of NGAL of the patient in the survival group was significantly decreased on D2[242.5 ng/ml (141.0-516.0) vs.223.0 ng/ml (110.0-462.0), P<0.05], and the level of NGAL of that is further increased on D7[242.5 ng/ml vs.161.0 ng/ml (99.0-260.0), P<0.05]. Compared with D1, the level of NGAL of the patient in the non-survival group has upward trend on D2[352.0 ng/ml (181.0-801.0) vs.413.0 ng/ml (224.5-1050.0), P=0.385], while the level of NGAL of that also has upward trend on D7 compared with D2[413.0 ng/ml (224.5-1050.0) vs.458.5 ng/ml (212.0-862.0), P=0.055]. Compared with Dl, the level of NGAL was significantly increased on D7[458.5 ng/ml (212.0-862.0) vs.352.0 ng/ml (181.0-801.0), P<0.05].Compared with the survival group, the level of NGAL of the non-survival group was significantly increased on D2 and D7 (P<0.05).3. Prognostic value of dynamic combined BNP and NGAL to patients with severe sepsis(1) Risk stratification of dynamic combined BNP and NGAL to patients with severe sepsis:there were no significant differences in regards to death risk of four groups on D1 and D2 (P>0.05), and there were no statistical meanings after the survival curves among four groups go through the Log-Rank and inspection (P>0.05). The death risk of the fourth group on D7 was significantly increased (RR=9.439,95.0%CI=1.259-70.756,P=0.029), and there were no statistical meanings after the survival curves among four groups go through the Log-Rank and inspection (P=0.003). Among them, the mortality of the fourth group was the highest, while that of the first group was the lowest.(2) Predictive value of dynamic combined BNP and NGAL to patients with severe sepsis: the analysis on ROC curve was made for BNP, NGAL, combination of BNP and NGAL on D1, D2 and D7. Among them, there were no significant differences in regards to three areas under the ROC curve on D1 and D2 (P>0.05), and the AUC of combination of BNP and NGAL was 0.856 on D7, which was obviously higher than that of individual BNP (0.749) or NGAL (0.759) on D7. The optimum predictive threshold value was BNP>113.0pg/ml or NGAL>303.0ng/ml; the sensitivity was 69.2%, and the specificity was 93.6%.Conclusions:The dynamic change of combination of BNP and NGAL was the good prognostic index for predicting patients with severe sepsis in the early phase. The combination of BNP and NGAL may early perform the risk stratification and well predict the prognosis patients with severe sepsis. |
PDF Full Text Request