Combination Of Multi-biomarker To Predict Myocardial Dysfunction And Mortality In Sepsis

Objective: The present study was to evaluate the feasibility of using the multibiomarker strategy for the prediction of sepsis-induced myocardial dysfunction(SIMD)and 28-day mortality in septic patients.Methods: Brain natriuretic peptide(BNP),cardiac troponin I(c Tn I),and heart-type fatty acid-binding protein(h-FABP)in 147 septic patients were assayed within 6 hours after admission.We also determined the plasma levels of myeloperoxidase(MPO)and pregnancy-associated plasma protein A(PAPPA).The receiver operating characteristics(ROC)curve was used to assess the best cut-off value of various single-biomarkers for the diagnosis of SIMD and the prediction of mortality.Also,the ROC curve,net reclassification improvement(NRI),and integrated discrimination improvement(IDI)indices were used to evaluate the feasibility of using multi-biomarkers to predict SIMD and mortality.Results: Our statistics revealed that only h-FABP independently predicted SIMD(P < 0.05).NRI and IDI indices were a more sensitive test for improving model discrimination than ROC curves.Although combined usage of three biomarkers significantly improve the ability to diagnose SIMD(h-FABP + MPO + c Tn I:NRI = 18.7%,P = 0.025;IDI = 3.3%,P = 0.033)and to predict 28-day mortality(MPO + h-FABP + PAPPA:NRI = 25.5%,P = 0.013;IDI = 2.9%,P = 0.045)in sepsis,the combination of two biomarkers fail to substantially improved both parameters(all P>0.05).Conclusions: The findings of this study indicate that a sensitive and specific strategy for early diagnosis of SIMD and 28-day mortality prediction in sepsis should incorporate three biomarkers.