Huang Hui-Bin, Xu Biao, Liu Guang-Yun, Du Bin
Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of Critical Care Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350001, China.
Ann Transl Med. 2019 Jun;7(12):264. doi: 10.21037/atm.2019.05.60.
The aim of this study is to examine whether plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration could predict fluid responsiveness in septic shock patients following fluid challenge (FC).
We reviewed prospectively collected data from 79 septic shock patients who received invasive cardiac output (CO) monitoring following a 500 mL FC. Haemodynamics were recorded, and blood sampling for NT-proBNP values was performed. Patients were divided into responders and non-responders according to fluid responsiveness, which was defined as cardiac index (CI) increase ≥10% induced by FC. The NT-proBNP and the CI changes were analysed using Pearson correlation. The area under the curve (AUC) for NT-proBNP was used to test its ability to distinguish responders and non-responders. Subgroup analyses were also explored.
Among 79 patients, there were 55 responders. High NT-proBNP values were common in the study cohort. Baseline NT-proBNP values were comparable between responders and non-responders. In general, NT-proBNP values were not significantly correlated with CI changes after FC (r=-0.104, P=0.361). Similarly, the NT-proBNP baseline values could not identify responders to FC with an AUC of 0.508 (95% confidence interval, 0.369-0.647). This result was further confirmed in the subgroup analyses.
Baseline NT-proBNP concentration value may not serve as an indicator of fluid responsiveness in patients with septic shock and should not be an indicator to withhold fluid loading.
本研究旨在探讨血浆N末端B型利钠肽原（NT-proBNP）浓度能否预测脓毒性休克患者液体复苏（FC）后的液体反应性。
我们回顾性分析了79例脓毒性休克患者的前瞻性收集数据，这些患者在接受500 mL FC后进行了有创心输出量（CO）监测。记录血流动力学指标，并采集血样检测NT-proBNP值。根据液体反应性将患者分为反应者和无反应者，液体反应性定义为FC诱导的心指数（CI）增加≥10%。采用Pearson相关性分析NT-proBNP与CI变化。用NT-proBNP的曲线下面积（AUC）来检验其区分反应者和无反应者的能力。还进行了亚组分析。
79例患者中，有55例为反应者。研究队列中NT-proBNP值普遍较高。反应者和无反应者的基线NT-proBNP值相当。总体而言，NT-proBNP值与FC后的CI变化无显著相关性（r=-0.104，P=0.361）。同样，NT-proBNP基线值不能识别FC反应者，AUC为0.508（95%置信区间，0.369-0.647）。亚组分析进一步证实了这一结果。
基线NT-proBNP浓度值可能不能作为脓毒性休克患者液体反应性的指标，也不应作为停止液体负荷的指标。
