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J Korean Soc Emerg Med > Volume 23(6); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(6): 853-861.
N-terminal Pro-Brain-type Natriuretic Peptide as a Prognostic Factor in Severe Sepsis and Septic Shock
Kwang Soo Bae, You Hwan Jo, Kyuseok Kim, Jae Hyuk Lee, Hyun Mi Park, Joong Eui Rhee
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea. drakejo@snubh.org
ABSTRACT
PURPOSE:
This study was performed to evaluate whether N-terminal pro-brain-type natriuretic peptide (NT-proBNP) could predict 28-day mortality in patients with severe sepsis and septic shock.
METHODS:
We performed a retrospective analysis of prospectively collected data from patients with severe sepsis and septic shock. Patients' demographic data, comorbidities, blood test results (including NT-proBNP concentration), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and nonsurvivors. NT-proBNP levels were categorized into quartiles by their concentration (< or =600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml). Multivariate Cox proportional hazard regression analysis was performed to identify the predictors of mortality during a 28-day follow-up period.
RESULTS:
Out of 349 patients, 117(33.5%) died. NT-proBNP concentrations were significantly higher in nonsurvivors compared to survivors (median 4,630 [IQR, 1,876-10,582] vs. 1,552 [IQR, 440-4,064] pg/ml, respectively, p<0.01). The mortality rate increased with increasing NT-proBNP concentrations; patients with NT-proBNP < or =600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml were 12.9%, 26.1%, 39.8%, and 51.1%, respectively. By Cox proportional hazards analysis, compared to patients with the lowest NT-proBNP levels (< or =600 pg/ml), patients in groups with higher NT-proBNP levels were more associated with 28-day mortality; 601 to 2,000 pg/ml (hazard ratio [HR], 1.15; 95% CI, 0.50-2.63); 2,001 to 6,000 pg/ml (HR, 2.10; 95% CI, 1.05-4.81); >600 pg/ml (HR, 2.30; 95% CI, 1.15-6.14).
CONCLUSION:
NT-proBNP is an independent prognostic factor for 28-day mortality in patients with severe sepsis and septic shock.
Key words: NT-proBNP, Sepsis, Mortality, Prognosis
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