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Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock.
Crit Care Med 2007; 35(5):1277-83CC

Abstract

OBJECTIVE

The aim of this study was to evaluate the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality in a large, unselected patient population with severe sepsis and septic shock.

DESIGN AND SETTING

Prospective observational cohort study about incidence and prognosis of sepsis in 24 intensive care units in Finland (the FINNSEPSIS study).

PATIENTS

A total of 254 patients with severe sepsis or septic shock.

MEASUREMENTS

After informed consent, the blood tests for NT-proBNP analyses were drawn on the day of admission and 72 hrs thereafter. Patients' demographic data were collected, and intensive care unit and hospital mortality and basic hemodynamic and laboratory data were recorded daily.

MAIN RESULTS

NT-proBNP levels at admission were significantly higher in hospital nonsurvivors (median, 7908 pg/mL) compared with survivors (median, 3479 pg/mL; p = .002), and the difference remained after 72 hrs (p = .002). The receiver operating characteristic curves of admission and 72-hr NT-proBNP levels for hospital mortality resulted in area under the curve values of 0.631 (95% confidence interval, 0.549-0.712; p = .002) and 0.648 (95% confidence interval, 0.554-0.741; p = .002), respectively. In logistic regression analyses, NT-proBNP values at 72 hrs after inclusion and Simplified Acute Physiology Score for the first 24 hrs were independent predictors of hospital mortality. Pulmonary artery occlusion pressure (p < .001), plasma creatinine clearance (p = .001), platelet count (p = .03), and positive blood culture (p = .04) had an independent effect on first-day NT-proBNP values, whereas after 72 hrs, only plasma creatinine clearance (p < .001) was significant in linear regression analysis.

CONCLUSION

NT-proBNP values are frequently increased in severe sepsis and septic shock. Values are significantly higher in nonsurvivors than survivors. NT-proBNP on day 3 in the intensive care unit is an independent prognostic marker of mortality in severe sepsis.

Authors+Show Affiliations

Department of Surgery, Helsinki University Hospital, Finland. marjut.varpula@hus.fiNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17414731

Citation

Varpula, Marjut, et al. "Predictive Value of N-terminal Pro-brain Natriuretic Peptide in Severe Sepsis and Septic Shock." Critical Care Medicine, vol. 35, no. 5, 2007, pp. 1277-83.
Varpula M, Pulkki K, Karlsson S, et al. Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock. Crit Care Med. 2007;35(5):1277-83.
Varpula, M., Pulkki, K., Karlsson, S., Ruokonen, E., & Pettilä, V. (2007). Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock. Critical Care Medicine, 35(5), pp. 1277-83.
Varpula M, et al. Predictive Value of N-terminal Pro-brain Natriuretic Peptide in Severe Sepsis and Septic Shock. Crit Care Med. 2007;35(5):1277-83. PubMed PMID: 17414731.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock. AU - Varpula,Marjut, AU - Pulkki,Kari, AU - Karlsson,Sari, AU - Ruokonen,Esko, AU - Pettilä,Ville, AU - ,, PY - 2007/4/7/pubmed PY - 2007/6/1/medline PY - 2007/4/7/entrez SP - 1277 EP - 83 JF - Critical care medicine JO - Crit. Care Med. VL - 35 IS - 5 N2 - OBJECTIVE: The aim of this study was to evaluate the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality in a large, unselected patient population with severe sepsis and septic shock. DESIGN AND SETTING: Prospective observational cohort study about incidence and prognosis of sepsis in 24 intensive care units in Finland (the FINNSEPSIS study). PATIENTS: A total of 254 patients with severe sepsis or septic shock. MEASUREMENTS: After informed consent, the blood tests for NT-proBNP analyses were drawn on the day of admission and 72 hrs thereafter. Patients' demographic data were collected, and intensive care unit and hospital mortality and basic hemodynamic and laboratory data were recorded daily. MAIN RESULTS: NT-proBNP levels at admission were significantly higher in hospital nonsurvivors (median, 7908 pg/mL) compared with survivors (median, 3479 pg/mL; p = .002), and the difference remained after 72 hrs (p = .002). The receiver operating characteristic curves of admission and 72-hr NT-proBNP levels for hospital mortality resulted in area under the curve values of 0.631 (95% confidence interval, 0.549-0.712; p = .002) and 0.648 (95% confidence interval, 0.554-0.741; p = .002), respectively. In logistic regression analyses, NT-proBNP values at 72 hrs after inclusion and Simplified Acute Physiology Score for the first 24 hrs were independent predictors of hospital mortality. Pulmonary artery occlusion pressure (p < .001), plasma creatinine clearance (p = .001), platelet count (p = .03), and positive blood culture (p = .04) had an independent effect on first-day NT-proBNP values, whereas after 72 hrs, only plasma creatinine clearance (p < .001) was significant in linear regression analysis. CONCLUSION: NT-proBNP values are frequently increased in severe sepsis and septic shock. Values are significantly higher in nonsurvivors than survivors. NT-proBNP on day 3 in the intensive care unit is an independent prognostic marker of mortality in severe sepsis. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17414731/Predictive_value_of_N_terminal_pro_brain_natriuretic_peptide_in_severe_sepsis_and_septic_shock_ L2 - http://Insights.ovid.com/pubmed?pmid=17414731 DB - PRIME DP - Unbound Medicine ER -