Multi-biomarker strategy for prediction of myocardial dysfunction and mortality in sepsis

Objective:The present study was to evaluate the feasibility of using the multi-biomarker strategy for the prediction of sepsis-induced myocardial dysfunction(SIMD)and mortality in septic patients.Methods:Brain natriuretic peptide(BNP),cardiac troponin I(cTnI),and heart-type fatty acid-binding protein(h-FABP)in 147 septic patients were assayed within 6 h after admission.We also determined the plasma levels of myeloperoxidase(MPO)and pregnancyassociated plasma protein-A(PAPP-A).The receiver operating characteristic(ROC)curve was used to assess the best cutoff values 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).The addition of MPO and cTnI to h-FABP for SIMD prediction provided an NRI of 18.7%(P=0.025)and IDI of 3.3%(P=0.033).However,the addition of MPO or cTnI to h-FABP did not significantly improve the predictive ability of h-FABP to SIMD,as evidenced by the area under the curve(AUC),NRI,and IDI(all P>0.05).A history of shock and MPO were independent predictors of mortality in septic patients(both P<0.05).The addition of PAPP-A and h-FABP to MPO resulted in a mortality prediction with NRI of 25.5%(P=0.013)and IDI of 2.9%(P=0.045).However,this study revealed that the addition of h-FABP or PAPP-A to MPO did not significantly improve the ability to predict mortality,as evidenced by the AUC,NRI,and IDI(all P>0.05).Conclusions:The findings of this study indicate that a sensitive and specific strategy for early diagnosis of SIMD and mortality prediction in sepsis should incorporate three biomarkers.