Clinical significance of dynamic monitoring of plasma Pro-B-type Natriuretic Peptide in the evaluation of prognostic value and myocardial dysfunction in patients with septic shock
10.3760/cma.j.issn.1008-6315.2012.12.011
- VernacularTitle:血浆B型钠尿肽前体浓度的动态变化对脓毒性休克患者心肌抑制严重程度及预后的评估意义
- Author:
Lijuan LI
;
Wei CHEN
;
Xuyun GU
;
Bo SHENG
;
Lei ZHAO
- Publication Type:Journal Article
- Keywords:
Septic shock;
Pro-B-type natriuretic peptide;
Prognosis
- From:
Clinical Medicine of China
2012;28(12):1268-1272
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the effects of dynamic monitoring of plasma Pro-B-type Natriuretic Peptide(Pro-BNP) in the evaluation of prognostic value and myocardial dysfunction in patients with septic shock.Methods The levels of plasma Pro-BNP were tested in 102 patients with septic shock on the 1,3,and 5 days.Data on ICU mortality and 28-day mortality were collected.The patients were divided into non-dysfunction group (CI<3.0) and cardiac dysfunction group (CI≥3.0) according to levels of hemodynamic variables ( CI level).The prognostic value of plasma Pro-BNP was analyzed.Results Plasma Pro-BNP levels on the 1,3 and 5 days in 28-day survivors have a significant declining trend [( 1649.0 ± 257.5 ) ng/L,( 1867.6 ± 291.7 ) ng/L vs.(1229.9 ± 194.5) ng/L),while plasma Pro-BNP levels in non-survivors have an increasing trend [(4128.8 ± 1051.1),( 5315.9 ± 925.4 ) vs.( 6899.9 ± 1327.9 ) ng/L].There is statistical significance of plasma Pro-BNP levels at day 1,3 and 5 for the two groups ( t=3.057,5.083,and 6.290 respectively,P<0.01 ).The 28-day mortality and Plasma Pro-BNP levels in cardiac dysfunction group were higher than of non-dysfunction group ( 28-day mortality:62.1% vs.20.0%;Pro-BNP1:( 1592.8 ± 362.2 )ng/L vs.( 4556.6 ±732.7 ) ng/L;Pro-BNP3:( 2933.6 ± 421.7 ) vs.( 5768.5 ± 793.7 ) ng/L,Pro-BNP5:( 3014.5 ± 587.5 ) ng/L vs.(8873.9 ± 1670.1) ng/L ( x2=20.635,P=0.000,t=3.626,3.154,3.310,P<0.01].Pro-BNP level greater than 3053 ng/L on the 5-day was an independent prognostic indicator of 28-day mortality ( sensitivity:88.4%;specificity:91.5 % ).Pro-BNP level greater than 2378 ng/L on the 5-day was an independent prognostic indicator of hospital mortality ( sensitivity:84.9%;specificity:91.8% ).In multivariate logistic regression analyses,Pro-BNP level and APACHE score were independent predictors of 28-day mortality and hospital mortality.Conclusion Plasma Pro-BNP level shows obvious significance in evaluation of sepsis-induced myocardial depression severity in patients with septic shock.Pro-BNP level in ICU at day 5 after inclusion is an independent prognostic marker of mortality in septic shock.