氨基末端B型脑钠肽前体与严重脓毒症、脓毒性休克患者死亡独立相关

Prognostic value of APACHE Ⅱ score, N-terminal pro-B-type natriuretic peptide and troponin-Ⅰ in patients with severe sepsis and septic shock

目的:探讨APACHEⅡ评分、氨基末端B型脑钠肽前体(NT-proBNP)和肌钙蛋白-Ⅰ(cTn-Ⅰ)在严重脓毒症与脓毒性休克患者预后的临床价值.方法:回顾分析严重脓毒症、脓毒性休克成年患者181例临床资料,根据入ICU治疗28 d后病情转归分为生存组127例和死亡组54例.Spearman分析与NT-proBNP、cTn-Ⅰ相关的因素;受试工作者(ROC)曲线分析APACHEⅡ评分、NT-proBNP、cTn-Ⅰ预测死亡的诊断效能;Logistic回归分析死亡的独立危险因素.结果:死亡组的APACHEⅡ评分、NT-proBNP和cTn-Ⅰ水平显著高于生存组;Spearman相关分析显示:NT-proBNP、cTn-Ⅰ分别与APACHEⅡ评分、受损脏器个数正相关;ROC曲线分析显示:APACHEⅡ评分、NT-proBNP、cTn-Ⅰ预测死亡的曲线下面积分别为0.873、0.752、0.655;多因素Logistic回归分析显示:APACHEⅡ评分、脓毒性休克、NT-proBNP>3.674μg/L是死亡的独立危险因素.结论:NT-proBNP对死亡风险评估有较好临床价值,APACHⅡ评分预测价值最好,cTn-Ⅰ诊断价值最弱.

Objective:To explore the prognostic value of APACHEⅡscore,N-terminal pro-B-type natriuretic peptide(NT-proBNP)and troponin-Ⅰ(cTn-Ⅰ)level in patients with severe sepsis and septic shock.Methods:Retrospectively,the clinical data of 181 adult patients with severe sepsis and septic shock were analyzed.The patients were divided into 4 survival group with 127 cases and non-survival group with 54 cases according to the prognosis after 28 days of ICU treatment.The factors correlated to NT-proBNP and troponin-Ⅰwas analyzed by spearman.Receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy of APACHEⅡscore,NT-proBNP and troponin-Ⅰin predict death,and to determine cut-off point.Logistic regression was used to analyze the independent risk factors for death.Results:The level of APACHEⅡscore,plasma troponin-Ⅰand NT-proBNP in non-survival group was significantly higher than that in survival group.The results of spearman correlative analysis showed that the level of troponin-Ⅰand NT-proBNP was positively correlated with APACHEⅡscore and number of damaged organs,respectively.The area under ROC curve of APACHEⅡscore,NT-proBNP and troponin-Ⅰin prediction of death was 0.873,0.752 and 0.655,respectively.In multivariate logistic regression analysis,APACHEⅡscore,septic shock and NT-proBNP>3.674μg/L were the independent risk factors for death.Conclusion:NT-proBNP is an independent predictive biomarker of poor prognosis in patients with severe sepsis and septic shock.The prognostic value of the APACHEⅡscore was the highest,while that of troponin-Ⅰwas the lowest.