血浆脑钠肽水平对老年重度脓毒症患者预后的影响

Effects of plasma brain natriuretic peptide on prognosis of elderly patients with severe sepsis

目的评价血浆脑钠肽（Brain Natriuretic Peptide，BNP）水平预测老年重度脓毒症患者死亡的价值。方法人选2004年5月至2007年6月在浙江医院重症监护室住院的重度脓毒症老年患者83例，均符合2001年美国胸科医师协会／危重病医学会（ACCP／SCCM）的重度脓毒症诊断标准，排除原有慢性肾功能衰竭患者。根据患者是否于28d内存活将其分为存活组和死亡组；比较两组患者入院第1天C-反应蛋白、危重病评分（APACHEⅡ和SOFA）、血浆BNP水平和第3天血浆BNP水平差异；其后以Logistic回归法分析患者年龄、入住ICU第1天血浆BNP、CRP水平、APACHEⅡ和SOFA评分、第3天血浆BNP水平等变量与患者28天死亡间的关系，同时确定其中预测ICU死亡的独立危险因素。结果死亡组老年重度脓毒症患者第1天和第3天血浆BNP水平与存活组相比均明显增高，分别为（1056．38±676．34）pg／ml vs．（611．59±610．02）pg／ml，P=0．002和（1448．48±891．11）vs．（522．41±575．20），P〈0．001。logistic回归分析发现，在年龄、APACHEⅡ、SOFA、CRP及第1天和第3天BNP水平诸因素中，第3天的BNP水平和SOFA评分为预测ICU死亡的独立危险因素。BNP水平与28d死亡率的ROC曲线分析示第1天和第3天BNP水平的曲线面积值分别为0．735（95％CI,0．621～0．848，P〈0．001）和0．836（95％CI，0．746—0．926，P〈0．001）。结论绝大多数老年重度脓毒症患者的血浆BNP水平明显升高，BNP可成为预测老年重度脓毒症患者预后的实验室指标。

Objective To evaluate the predictive value of brain natriuretic peptide （BNP） on mortality in elderly patient with severe sepsis or septic shock. Method Eighty-three elderly patients meeting with criteria of severe sepsis or septic shock by the American College of Chest Physicians and the Society of Critical Care Medicine （ACCP/SCCM） in 2001, admitted in Intensive Care Unit （ICU） of Zhejiang Hospital during May 2004 to June 2007, were enrolled, and patients with chronic renal failure were excluded. The patients were divided into survivor and non - survivor group according to whether they survived within 28 days staying in ICU, the difference of plasma BNP level, serum C-creative protein （CRP） concentration, APACHE II and SOFA scores on admission day and BNP level on the third day between the two groups were compared; thereafter, the relationship between multiple variables including age, admission day, BNP, CRP, APACHE II and SOFA scores, the 3rd day BNP level and 28- day mortality were analyzed by Logistic regression, and meanwhile the independent predictors for ICU mortality among which were determined. Results BNP levels on both admission day and the 3rd day were significantly higher in nonsurvivor group than those in survivor group[ （1056.38± 676.34） pg/ml vs. （611.59 ± 610.02） pg/ml, P = 0.002 and （ 1448.48 ± 891.11） pg/ml vs. （522.41 ± 575.20） pg/ml, P 〈 0.001, respectively ]. By Logistic regression analysis, BNP level on the 3rd day and SOFA score on admission day were independent predictors of ICU mortality, The receiver operating characteristic （ROC） curves indicated that values of areas under the curve of the admission day and the 3rd day BNP levels for 28-days mortality were 0.735 （95% CI, 0.621 - 0. 848, P 〈0.001） and0.836 （95% CI, 0.746 - 0.926,P 〈0.001）, respectively. Conclusions Plasma BNP increaseds in majority of elderly patients with severe sepsis or septic shock, which may serve as index for prognosis in elderly severe septic patients.