The Third Affiliated Hospital of Soochow University, Changzhou, China.
Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Blood Purif. 2019;48(3):262-271. doi: 10.1159/000501388. Epub 2019 Jul 16.
Sepsis is a complex clinical syndrome leading to severe sepsis and septic shock. It is very common in the intensive care unit with high mortality. Thus, judging its prognosis is extremely important. Procalcitonin (PCT) and -N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are commonly elevated in sepsis patients, but only a few are discussed in the septic acute kidney injury patients (AKI) who received renal replacement therapy (RRT). Our study is aimed at investigating the prognostic value of PCT and NT-proBNP in septic AKI patients who received RRT.
This was a retrospective study of septic AKI patients who underwent RRT in a Chinese university hospital. All enrolled patients tested PCT and NT-proBNP at RRT initiation. PCT and NT-proBNP levels were compared between the survivors and non-survivors. Receiver operating characteristic (ROC) curves of the 2 biomarkers were performed for predicting in-hospital mortality. According to the median value of PCT (16.2 ng/mL) and NT-proBNP (10,271 pg/mL), patients were divided into 4 groups (low PCT and low NT-proBNP; high PCT and low NT-proBNP; low PCT and high NT-proBNP; high PCT and high NT-proBNP). The Kaplan-Meier survival curves were used to analyze the 28-day survival rate in the 4 groups.
A total of 81 patients were enrolled in the study. Of which, 48 (59.3%) patients died during hospitalization. The median of NT-proBNP in non-survivors was significantly higher than in survivors (p = 0.001), while PCT had no significant difference (p = 0.412). The area under the ROC curve of PCT and NT-proBNP for predicting in-hospital mortality was 0.561 (95% CI 0.426-0.695) and 0.729 (95% CI 0.604-0.854). Kaplan-Meier survival curve analysis showed that increased NT-proBNP level was associated with 28-day mortality while combined with PCT there was no statistical difference in 4 different level groups.
NT-proBNP has a certain predictive value for the prognosis in septic AKI patients who received RRT. It seems that the initial PCT value for prognosis is limited. The combination of PCT and -NT-proBNP to evaluate the prognosis in these critically ill patients is currently unclear.
败血症是一种导致严重败血症和败血症性休克的复杂临床综合征。它在重症监护病房中非常常见，死亡率很高。因此，判断其预后极为重要。降钙素原（PCT）和 N 端脑利钠肽前体（NT-proBNP）在败血症患者中通常升高，但在接受肾脏替代治疗（RRT）的败血症急性肾损伤（AKI）患者中，只有少数得到了讨论。我们的研究旨在探讨 PCT 和 NT-proBNP 在接受 RRT 的败血症 AKI 患者中的预后价值。
这是一项对在中国一家大学医院接受 RRT 的败血症 AKI 患者进行的回顾性研究。所有入组患者均在 RRT 开始时检测 PCT 和 NT-proBNP。比较存活者和非存活者之间的 PCT 和 NT-proBNP 水平。对 2 种生物标志物进行受试者工作特征（ROC）曲线分析，以预测住院死亡率。根据 PCT（16.2ng/ml）和 NT-proBNP（10271pg/ml）中位数将患者分为 4 组（低 PCT 和低 NT-proBNP；高 PCT 和低 NT-proBNP；低 PCT 和高 NT-proBNP；高 PCT 和高 NT-proBNP）。Kaplan-Meier 生存曲线用于分析 4 组患者的 28 天生存率。
共有 81 例患者入组。其中，48 例（59.3%）患者在住院期间死亡。非存活者的 NT-proBNP 中位数明显高于存活者（p=0.001），而 PCT 无显著差异（p=0.412）。PCT 和 NT-proBNP 预测住院死亡率的 ROC 曲线下面积分别为 0.561（95%CI0.426-0.695）和 0.729（95%CI0.604-0.854）。Kaplan-Meier 生存曲线分析显示，NT-proBNP 水平升高与 28 天死亡率相关，而与 PCT 联合时，4 个不同水平组之间无统计学差异。
NT-proBNP 对接受 RRT 的败血症 AKI 患者的预后有一定的预测价值。似乎 PCT 初始值对预后的预测价值有限。目前尚不清楚 PCT 和 NT-proBNP 联合评估这些危重症患者的预后。
