脑钠肽作为重症监护患者预后标志物的效用。
The utility of brain natriuretic peptide as a prognosticating marker in critical care patients.
作者信息
Naidoo A, de Vasconcellos K
机构信息
Department of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
Department of Critical Care, King Edward VIII Hospital, Durban, and Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
出版信息
South Afr J Crit Care. 2023 Dec 13;39(3):e1218. doi: 10.7196/SAJCC.2023.v39i3.1218. eCollection 2023.
BACKGROUND
Brain natriuretic peptide (BNP) is an established biomarker of morbidity and mortality in cardiac failure. Data also suggest potential prognostic utility in non-heart failure cohorts. The utility of BNP in predicting intensive care unit (ICU) outcomes has not been well evaluated in a mixed critical care population in the South African (SA) context.
OBJECTIVES
To evaluate the ability of BNP to predict ICU mortality in a heterogeneous critical care population in SA.
METHODS
This was a retrospective observational study of 100 patients admitted to a multidisciplinary, closed, intensivist-run ICU in a tertiary academic hospital serving KwaZulu-Natal Province (1 January 2020 - 31 July 2022). Initial BNP was evaluated as a predictor of ICU mortality using univariate and multivariable analyses.
RESULTS
There was a statistically significant difference in BNP between survivors and non-survivors in the cohort of patients without heart failure. The median initial BNP in the non-heart failure cohort was 411 (interquartile range (IQR) 116 - 848) ng/L in non-survivors, and 150 (44 - 356) ng/L in survivors (p=0.028). The optimal cut-off for BNP was determined as 366 ng/L. A BNP ≥366 ng/L was an independent predictor of ICU outcome.
CONCLUSION
This study highlights the potential utility of BNP as a predictor of ICU mortality in a heterogeneous ICU population, with the greatest utility in patients without heart failure. Further studies are required to confirm this finding.
CONTRIBUTION OF THE STUDY
The study is a retrospective, observational study conducted in multidisciplinary, closed, intensivist-run ICU at a tertiary academic hospital. It showed an elevated BNP is associated with increased ICU mortality, particularly in those without a baseline diagnosis of heart failure. This identifies the need for further prospective studies evaluating BNP as a prognostic marker in non-cardiac critically ill patients, and its utility as an addition in pre-existing ICU outcome prediction scores.
背景
脑钠肽（BNP）是心力衰竭发病率和死亡率的既定生物标志物。数据还表明其在非心力衰竭人群中具有潜在的预后价值。在南非背景下的混合重症监护人群中，BNP在预测重症监护病房（ICU）结局方面的效用尚未得到充分评估。
目的
评估BNP在南非异质性重症监护人群中预测ICU死亡率的能力。
方法
这是一项对100例入住夸祖鲁-纳塔尔省一家三级学术医院多学科、封闭式、由重症医学专家管理的ICU患者的回顾性观察研究（2020年1月1日至2022年7月31日）。使用单变量和多变量分析评估初始BNP作为ICU死亡率的预测指标。
结果
在无心力衰竭的患者队列中，幸存者和非幸存者的BNP存在统计学显著差异。非心力衰竭队列中，非幸存者的初始BNP中位数为411（四分位间距（IQR）116 - 848）ng/L，幸存者为150（44 - 356）ng/L（p = 0.028）。确定BNP的最佳截断值为366 ng/L。BNP≥366 ng/L是ICU结局的独立预测指标。
结论
本研究强调了BNP作为异质性ICU人群中ICU死亡率预测指标的潜在效用，在无心力衰竭的患者中效用最大。需要进一步研究来证实这一发现。
研究贡献
本研究是在一家三级学术医院的多学科、封闭式、由重症医学专家管理的ICU中进行的回顾性观察研究。研究表明BNP升高与ICU死亡率增加相关，特别是在那些无心力衰竭基线诊断的患者中。这表明需要进一步开展前瞻性研究，评估BNP作为非心脏重症患者预后标志物的作用，以及其作为现有ICU结局预测评分补充指标的效用。
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