Division of Anaesthesiology, Department of Medical & Health Sciences, Linköping University, Linköping, Sweden.
Eur J Anaesthesiol. 2012 Jun;29(6):275-9. doi: 10.1097/EJA.0b013e32835470a8.
Amino-terminal pro-brain-type natriuretic peptide is known to predict outcome in patients with heart failure, but its role in an intensive care setting is not yet fully established.
To assess the incidence of elevated amino-terminal pro-brain natriuretic peptide (NT-pro-BNP) on admission to intensive care and its relation to death in the ICU and within 30 days.
Prospective, observational cohort study.
A mixed non-cardiothoracic tertiary ICU in Sweden.
NT-pro-BNP was collected from 481 consecutive patients on admission to intensive care, in addition to data on patient characteristics and outcome. A receiver-operating characteristic curve was used to identify a discriminatory level of significance, a stepwise logistic regression analysis to correct for other clinical factors and a Kaplan-Meier analysis to assess survival. The correlation between Simplified Acute Physiology Score (SAPS) 3, Sequential Organ Failure Assessment score (SOFA) and NT-pro-BNP was analysed using Spearman's correlation test. Quartiles of NT-pro-BNP elevation were compared for baseline data and outcome using a logistic regression model.
An NT-pro-BNP more than 1380 ng -l on admission was an independent predictor of death in the ICU and within 30 days [odds ratio (OR) 2.6; 95% confidence interval (CI), 1.5 to 4.4] and was present in 44% of patients. Thirty-three percent of patients with NT-pro-BNP more than 1380 ng -1, and 14.6% of patients below that threshold died within 30 days (log rank P=0.005). NT-pro-BNP correlated moderately with SAPS 3 and with SOFA on admission (Spearman's ρ 0.5552 and 0.5129, respectively). In quartiles of NT-pro-BNP elevation on admission, severity of illness and mortality increased significantly (30-day mortality 36.1%; OR 3.9; 95% CI, 2.0 to 7.3 in the quartile with the highest values, vs. 12.8% in the lowest quartile).
We conclude that NT-pro-BNP is commonly elevated on admission to intensive care, that it increases with severity of illness and that it is an independent predictor of mortality.
已知氨基末端脑利钠肽前体（NT-pro-BNP）可预测心力衰竭患者的预后，但它在重症监护环境中的作用尚未完全确定。
评估重症监护患者入院时 NT-pro-BNP 升高的发生率及其与 ICU 内和 30 天内死亡的关系。
前瞻性观察队列研究。
瑞典一家混合非心胸重症监护 ICU。
除患者特征和结局数据外，还在重症监护患者入院时采集 NT-pro-BNP。使用受试者工作特征曲线确定有统计学意义的分界值，逐步逻辑回归分析校正其他临床因素，Kaplan-Meier 分析评估生存。使用 Spearman 相关检验分析简化急性生理学评分（SAPS）3、序贯器官衰竭评估评分（SOFA）与 NT-pro-BNP 的相关性。使用逻辑回归模型比较 NT-pro-BNP 升高的四分位数的基线数据和结局。
入院时 NT-pro-BNP 超过 1380ng/L 是 ICU 内和 30 天内死亡的独立预测因素[比值比（OR）2.6；95%置信区间（CI），1.5 至 4.4]，在 44%的患者中存在。NT-pro-BNP 超过 1380ng/L 的 33%患者和低于该阈值的 14.6%患者在 30 天内死亡（对数秩 P=0.005）。NT-pro-BNP 与入院时的 SAPS 3 和 SOFA 中度相关（Spearman's ρ分别为 0.5552 和 0.5129）。入院时 NT-pro-BNP 升高的四分位数中，严重程度和死亡率显著增加（30 天死亡率分别为 36.1%、OR 3.9；95%CI，2.0 至 7.3 在四分位数最高者中，而最低四分位数者为 12.8%）。
我们的结论是，NT-pro-BNP 在重症监护患者入院时通常升高，其随疾病严重程度而增加，是死亡率的独立预测因素。
