Department of Medical Education, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China; Department of Digestive Internal Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Ann Palliat Med. 2021 May;10(5):5561-5567. doi: 10.21037/apm-21-1048. Epub 2021 May 18.
To study the predictive value of B-type natriuretic peptide (BNP) and soluble thrombomodulin (sTM) in the severity stratification and prognosis evaluation of sepsis.
The clinical data of 137 sepsis patients diagnosed and treated in Sichuan Provincial People's Hospital from May 2018 to November 2020 were retrospectively analyzed. Meanwhile, 121 healthy individuals were selected as the control group. Patients with sepsis were allocated into the mild group, severe group, and shock group according to the severity. According to the 28-day prognosis, the patients were allocated into the death group and survival group. The plasma BNP and serum sTM levels in different groups were compared, and their prognostic value was evaluated.
Patients with sepsis had significantly higher levels of BNP and sTM than the healthy control group (P<0.05). The levels of BNP and sTM in the mild group were significantly lower than those in the severe group and shock group, and both BNP and sTM were positively correlated with Acute Physiology and Chronic Health Status (APACHE) II score (r=0.595, 0.516, P<0.05). The levels of BNP and sTM in the death group were significantly higher than those in the survival group (P<0.05). The area under curve (AUC) of BNP combined with sTM was significantly greater than that of BNP or sTM alone for the prognosis of sepsis (P<0.05). When the cut-off value of BNP was 625.68 pg/mL, the sensitivity and specificity were 77.42% and 89.42%, respectively. When the cut-off value of sTM was 10.53 ng/mL, the sensitivity and specificity were 83.87% and 94.34%, respectively.
Patients with sepsis have significantly higher serum BNP and sTM levels which are positively correlated with the severity of the disease. Both of the 2 indexes have good prognostic value, and the predictive value is higher when combined.
研究脑钠肽（BNP）和可溶性血栓调节蛋白（sTM）在脓毒症严重程度分层和预后评估中的预测价值。
回顾性分析 2018 年 5 月至 2020 年 11 月四川省人民医院收治的 137 例脓毒症患者的临床资料，同时选择 121 例健康者作为对照组。根据病情严重程度将脓毒症患者分为轻症组、重症组和休克组，根据 28 天预后将患者分为死亡组和存活组。比较不同组患者的血浆 BNP 和血清 sTM 水平，并评估其预后价值。
脓毒症患者的 BNP 和 sTM 水平均显著高于健康对照组（P<0.05）。轻症组的 BNP 和 sTM 水平显著低于重症组和休克组，且两者均与急性生理学与慢性健康状况评分系统（APACHE）Ⅱ评分呈正相关（r=0.595、0.516，P<0.05）。死亡组的 BNP 和 sTM 水平显著高于存活组（P<0.05）。BNP 联合 sTM 的曲线下面积（AUC）明显大于 BNP 或 sTM 单独预测脓毒症预后的 AUC（P<0.05）。当 BNP 的截断值为 625.68 pg/mL 时，其灵敏度和特异度分别为 77.42%和 89.42%；当 sTM 的截断值为 10.53 ng/mL 时，其灵敏度和特异度分别为 83.87%和 94.34%。
脓毒症患者的血清 BNP 和 sTM 水平显著升高，且与疾病严重程度呈正相关。这两个指标均具有良好的预后价值，联合预测价值更高。
