Seligman Renato, Papassotiriou Jana, Morgenthaler Nils G, Meisner Michael, Teixeira Paulo J Z
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Intensive Care Med. 2008 Nov;34(11):2084-91. doi: 10.1007/s00134-008-1173-x. Epub 2008 Jun 4.
This study aimed to investigate the correlation of midregional pro-atrial natriuretic peptide (MR-proANP) with severity of septic status in patients with ventilator-associated pneumonia (VAP) and the usefulness of MR-proANP for mortality prediction in VAP.
Prospective observational cohort study.
University Hospital.
Seventy-one patients consecutively admitted to ICU who developed VAP. Patients were followed for 28 days after diagnosis, when they were considered survivors. There were no interventions.
MR-proANP levels increased from sepsis to severe sepsis and septic shock on D0 and D4 of VAP (0.002 and 0.02 respectively). Median MR-proANP levels on day 0 and day 4 (pmol/L [interquartile range]) were 149.0 (79.8-480.0) and 249.0 (93.6-571.0) in septic patients, 438.5 (229.3-762.0) and 407.5 (197.8-738.0) in severe sepsis, 519.5 (369.5-1282.3) and 632.0 (476.0-1047.5) in septic shock. On day 0 and day 4, MR-proANP levels were significantly higher in non-survivors (525.0 [324.0-957.8] and 679.5 [435.0-879.5], respectively) than in survivors (235.0 [102.0-535.0] and 254.0 [110.0-571.0], respectively; P = 0.004). Univariate logistic regression model for mortality included age, gender, APACHE II score, creatinine, logarithmic transformed MR-proANP (LnMR-proANP). Mortality was directly related to LnMR-proANP on D0 and D4, with odds ratios (OR) of 2.06 (95% CI 1.21-3.51) and 2.63 (1.33-5.23), respectively. In multivariate logistic regression, only LnMR-proANP D0 with OR = 2.35 (1.05-5.26) and LnMR-proANP D4 with OR = 3.76 (1.39-10.18) remained significant.
Our data demonstrated that MR-proANP levels increase progressively with the severity of sepsis and are independent predictors of mortality in VAP.
本研究旨在探讨中段心房利钠肽前体（MR-proANP）与呼吸机相关性肺炎（VAP）患者脓毒症状态严重程度的相关性，以及MR-proANP在预测VAP患者死亡率方面的作用。
前瞻性观察队列研究。
大学医院。
71例连续入住重症监护病房（ICU）并发生VAP的患者。诊断后对患者进行28天随访，此时他们被视为幸存者。未进行干预。
在VAP的第0天和第4天，MR-proANP水平从脓毒症到严重脓毒症和脓毒性休克逐渐升高（分别为0.002和0.02）。脓毒症患者第0天和第4天的MR-proANP中位数水平（pmol/L[四分位间距]）分别为149.0（79.8 - 480.0）和249.0（93.6 - 571.0），严重脓毒症患者为438.5（229.3 - 762.0）和407.5（197.8 - 738.0），脓毒性休克患者为519.5（369.5 - 1282.3）和632.0（476.0 - 1047.5）。在第0天和第4天，非幸存者的MR-proANP水平（分别为525.0[324.0 - 957.8]和679.5[435.0 - 879.5]）显著高于幸存者（分别为235.0[102.0 - 535.0]和254.0[110.0 - 571.0]；P = 0.004）。死亡率的单因素逻辑回归模型包括年龄、性别、急性生理学与慢性健康状况评分系统II（APACHE II）评分、肌酐、对数转换后的MR-proANP（LnMR-proANP）。死亡率与第0天和第4天的LnMR-proANP直接相关，比值比（OR）分别为2.06（95%CI 1.21 - 3.51）和2.63（1.33 - 5.23）。在多因素逻辑回归中，只有第0天的LnMR-proANP（OR = 2.35[1.05 - 5.26]）和第4天的LnMR-proANP（OR = 3.76[1.39 - 10.18]）仍然具有显著性。
我们的数据表明，MR-proANP水平随着脓毒症严重程度的增加而逐渐升高，并且是VAP患者死亡率的独立预测指标。
