Vallabhajosyula Saarwaani, Wang Zhen, Murad M Hassan, Vallabhajosyula Shashaank, Sundaragiri Pranathi R, Kashani Kianoush, Miller Wayne L, Jaffe Allan S, Vallabhajosyula Saraschandra
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc Innov Qual Outcomes. 2020 Jan 8;4(1):50-64. doi: 10.1016/j.mayocpiqo.2019.10.008. eCollection 2020 Feb.
Data are conflicting regarding the optimal cutoffs of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to predict short-term mortality in patients with sepsis. We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus) for English-language reports of studies evaluating adult patients with sepsis, severe sepsis, and septic shock with BNP/NT-proBNP levels and short-term mortality (intensive care unit, in-hospital, 28-day, or 30-day) published from January 1, 2000, to September 5, 2017. The average values in survivors and nonsurvivors were used to estimate the receiver operating characteristic curve (ROC) using a parametric regression model. Thirty-five observational studies (3508 patients) were included (median age, 51-75 years; 12%-74% males; cumulative mortality, 34.2%). A BNP of 622 pg/mL had the greatest discrimination for mortality (sensitivity, 0.695 [95% CI, 0.659-0.729]; specificity, 0.907 [95% CI, 0.810-1.003]; area under the ROC, 0.766 [95% CI, 0.734-0.797]). An NT-proBNP of 4000 pg/mL had the greatest discrimination for mortality (sensitivity, 0.728 [95% CI, 0.703-0.753]; specificity, 0.789 [95% CI, 0.710-0.867]; area under the ROC, 0.787 [95% CI, 0.766-0.809]). In prespecified subgroup analyses, identified BNP/NT-proBNP cutoffs had higher discrimination if specimens were obtained 24 hours or less after admission, in patients with severe sepsis/septic shock, in patients enrolled after 2010, and in studies performed in the United States and Europe. There was inconsistent adjustment for renal function. In this hypothesis-generating analysis, BNP and NT-proBNP cutoffs of 622 pg/mL and 4000 pg/mL optimally predicted short-term mortality in patients with sepsis. The applicability of these results is limited by the heterogeneity of included patient populations.
关于B型利钠肽（BNP）和N末端B型利钠肽原（NT-proBNP）预测脓毒症患者短期死亡率的最佳临界值，数据存在冲突。我们全面检索了多个数据库（MEDLINE、EMBASE、Cochrane对照试验中心注册库、Cochrane系统评价数据库和Scopus），以查找2000年1月1日至2017年9月5日发表的评估成年脓毒症、严重脓毒症和脓毒性休克患者BNP/NT-proBNP水平及短期死亡率（重症监护病房、住院期间、28天或30天）的英文研究报告。使用参数回归模型，用幸存者和非幸存者的平均值来估计受试者工作特征曲线（ROC）。纳入了35项观察性研究（3508例患者）（中位年龄51 - 75岁；男性占12% - 74%；累积死亡率34.2%）。BNP为622 pg/mL时对死亡率的判别力最强（敏感性0.695 [95%CI，0.659 - 0.729]；特异性0.907 [95%CI，0.810 - 1.003]；ROC曲线下面积0.766 [95%CI，0.734 - 0.797]）。NT-proBNP为4000 pg/mL时对死亡率的判别力最强（敏感性0.728 [95%CI，0.703 - 0.753]；特异性0.789 [95%CI，0.710 - 0.867]；ROC曲线下面积0.787 [95%CI，0.766 - 0.809]）。在预先设定的亚组分析中，如果在入院后24小时或更短时间内获取标本、在严重脓毒症/脓毒性休克患者中、在2010年后入组的患者中以及在美国和欧洲进行的研究中，所确定的BNP/NT-proBNP临界值对死亡率的判别力更高。对肾功能的调整存在不一致性。在这项产生假设的分析中，BNP和NT-proBNP临界值分别为622 pg/mL和4000 pg/mL时能最佳预测脓毒症患者的短期死亡率。这些结果的适用性受到纳入患者群体异质性的限制。
