Qian A, Zhang M, Zhao G
Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China,
Eur J Trauma Emerg Surg. 2015 Feb;41(1):57-64. doi: 10.1007/s00068-014-0406-7. Epub 2014 Jun 3.
NT-proBNP and BNP have been demonstrated to be prognostic markers in cardiac disease and sepsis. However, the prognostic value and the dynamic changes of BNP or NT-proBNP in trauma patients remain unclear. The present study was conducted to investigate the dynamic changes of NT-proBNP in patients with major trauma (injury severity score ≥16), determine whether NT-proBNP could be used as a simple index to predict mortality in major trauma patients.
This prospective observational study included 60 patients with major trauma. Serum NT-proBNP levels were measured on the 1st, 3rd and 7th day after injury The NT-proBNP levels in survivors were compared with those in non-survivors. The efficacy of NT-proBNP to predict survival was analyzed using receiver operating characteristic curves. An analysis of correlations between NT-proBNP and various factors, including injury severity score, Glasgow coma score, acute physiology and chronic health evaluation II, central venous pressure, creatine kinase-MB, cardiac troponin I and procalcitonin (PCT) was performed. NT-proBNP levels in patients with traumatic brain injury were compared with those in patients without traumatic brain injury. A comparison of NT-proBNP levels between patients with and without sepsis was also performed at each time point.
NT-proBNP levels in non-survivors were significantly higher than those in survivors at all the indicated time points. In the group of non-survivors, NT-proBNP levels on the 7th day were markedly higher than those on the 1st day. In contrast, NT-proBNP levels in survivors showed a reduction over time. The efficacy of NT-proBNP to predict survival was analyzed using ROC curves, and there was no difference in the area under the ROC between NT-proBNP and APACHE II/ISS at the three time points. A significant correlation was found between NT-proBNP and ISS on the 1st day, NT-proBNP and CK-MB, Tn-I and APACHE II on the 3rd day, NT-proBNP and PCT on the 7th day. There were no significant differences in NT-proBNP levels between patients with or without brain trauma at all the indicated time points. NT-proBNP levels in patients with sepsis were significantly higher than those in patients without sepsis at all the indicated time points.
These findings suggest that dynamic detection of serum NT-proBNP might help to predict death in patients with major trauma. A high level of NT-proBNP at admission or maintained for several days after trauma indicates poor survival.
N末端B型利钠肽原（NT-proBNP）和B型利钠肽（BNP）已被证明是心脏病和脓毒症的预后标志物。然而，BNP或NT-proBNP在创伤患者中的预后价值及动态变化仍不清楚。本研究旨在调查严重创伤（损伤严重度评分≥16）患者NT-proBNP的动态变化，确定NT-proBNP是否可作为预测严重创伤患者死亡率的一个简单指标。
这项前瞻性观察性研究纳入了60例严重创伤患者。在受伤后第1天、第3天和第7天测量血清NT-proBNP水平。将存活患者的NT-proBNP水平与非存活患者的进行比较。使用受试者工作特征曲线分析NT-proBNP预测生存的效能。对NT-proBNP与各种因素之间的相关性进行分析，这些因素包括损伤严重度评分、格拉斯哥昏迷评分、急性生理与慢性健康状况评分II、中心静脉压、肌酸激酶同工酶MB、心肌肌钙蛋白I和降钙素原（PCT）。比较了创伤性脑损伤患者与无创伤性脑损伤患者的NT-proBNP水平。在每个时间点还比较了有脓毒症和无脓毒症患者的NT-proBNP水平。
在所有指定时间点，非存活患者的NT-proBNP水平均显著高于存活患者。在非存活患者组中，第7天的NT-proBNP水平明显高于第1天。相比之下，存活患者的NT-proBNP水平随时间降低。使用ROC曲线分析NT-proBNP预测生存的效能，在三个时间点NT-proBNP与急性生理与慢性健康状况评分II/损伤严重度评分的ROC曲线下面积无差异。发现第1天NT-proBNP与损伤严重度评分、第3天NT-proBNP与肌酸激酶同工酶MB、肌钙蛋白I和急性生理与慢性健康状况评分II、第7天NT-proBNP与降钙素原之间存在显著相关性。在所有指定时间点，有或无脑外伤患者的NT-proBNP水平无显著差异。在所有指定时间点，有脓毒症患者的NT-proBNP水平均显著高于无脓毒症患者。
这些发现表明，动态检测血清NT-proBNP可能有助于预测严重创伤患者的死亡。入院时或创伤后持续数天的高水平NT-proBNP表明生存预后不良。
