血浆氨基末端脑钠肽前体对老年重症肺部感染患者的预测价值

Prognostic value of plasma N-terminal pro-brain natriuretic peptide levels in the elderly with severe pulmonary infection

目的评价血浆氨基末端脑钠肽前体(NT-proBNP)对重症监护病房(ICU)老年重症肺部感染患者30d内死亡的预测价值。方法回顾性分析我院各ICU2009年1月至2009年12月因重症肺部感染入住ICU的老年患者。入选38例患者,并根据30d内存活情况分为存活组(26例)和死亡组(12例),以成组t检验及卡方检验比较两组间年龄、性别、既往史、NT-proBNP对数值(logNT-proBNP)、急性病生理学和长期健康评价(APACHE)Ⅱ评分;应用受试者工作特征(ROC)曲线,评价NT-proBNP水平对患者30d内死亡的预测价值。结果两组患者年龄、性别、既往史比较,差异均无统计学意义(P均>0.05)。死亡组logNT-proBNP和APACHEⅡ分值均明显高于存活组(P均<0.05)。NT-proBNP预测死亡的ROC曲线下面积为0.865(95%置信区间0.741～0.990),其预测30d死亡的截点值为2385.5ng/L。结论血浆NT-proBNP对入住ICU的老年重症肺部感染患者的预后具有较好的预测价值。血浆NT-proBNP浓度>2385.5ng/L的患者预后不佳。

Objective To evaluate the predictive value of N-terminal pro-brain natriuretic peptide （NT-proBNP） on 30-day mortality in the elderly with severe pulmonary infection in intensive care unit （ICU）. Methods The data of the elderly patients with severe pulmonary infection after ICU admission, from January to November in 2009, were retrospectively analyzed. Thirty-eight elderly patients were enrolled in this study and then divided into the survival group （26 cases） and death group （12 cases） according to the 30-day survival condition. The age, gender, past history, acute physiology and chronic health evaluation （APACHE） Ⅱ scores and serum NT-proBNP levels were compared between the two groups by group t test and variance test. The receiver operating characteristic （ROC） curve was drawn to evaluate the value of serum NT-proBNP in predicting 30-day mortality. Results There were no differences in age, gender and past history between the two groups. The NT-proBNP and APACHE Ⅱ score in death group were significantly higher than the survival group （all P〈0.05）. In the ROC analysis for the prediction of death, the area under the ROC curve for NT-proBNP was 0.865 （95% confidence interval 0.741-0.990）, and the optimal cut-point for NT-proBNP was 2385.5 ng/L. Conclusions NT-proBNP is a prognostic marker of mortality in the elderly with severe pulmonary infection after ICU admission. Patients with NT-proBNP levels above the cut-point might have higher odds of mortality.