The Relationship Between NT-pro-BNP Levels And Clinical Prognosis In Patients With Septic Shock

Objective: With the increase of pathogenic microorganisms drug-resistanting andimmune system suppression patients, sepsis shock related deaths has becoming aserious problem worldwide. Although a lot of new technologies for the treatment ofsepsis shock is emergencing in recent years, the mortality rate of this disease is stillhigh. Recent years, scholars have investmented more research in patients with septicshock, trying to find more highly sensitivity and specificity clinical indicators as thebasis of the septic shock condition, in order to Measure the risk stratification ofpatients with sepsis and predict the patient’s clinical prognosis in early stage. Theinflammatory response Production of C-reactive protein and procalcitonin was used bymost scholars to determine the condition of sepsis shock. Recent clinical studies havefound that the Human N-terminal pro-brain natriuretic peptide has important directingSignificance for the severity and clinical outcome in patients with septic shock. But thepatients with septic shock is often associated with cardiac dysfunction, and affectNT-pro-BNP levels.Therefore, we excluded patients with cardiac dysfunction, andstudied the related risk factors for septic shock, and explore the advantages ofC-reactive protein, procalcitonin and NT-pro-BNP levels in the evaluation of clinicaloutcomes in patients with septic shock.Methods: We Collected96patients in Second Affiliated Hospital of DalianMedical University from December2010to December2012being in line with septicshock, and divided the patients into survival group and death group according thesurviving at28days. All patients had conducted right heart catheterization ortransthoracic echocardiography to rule out the possible effects of congestive heartfailure factors on experimental results. We analyzed the relationship among patient’sage, time of onset, ICU length of stay, time of antibiotics, vasoactive drug application,the site of infection, pathogen species, underlying disease state, NT-pro-BNP levels, C-reactive protein, serum procalcitonin, APACHEII score and28-day mortality.Results: The mortality rate of96Patients with septic shock was36.458%.ByUnivariate analysis we found that NT-pro-BNP levels (The survival group was732.1±265.8, The group of death was1226.5±276.2, P<0.001), C-reactive protein (Thesurvival group was84.85±30.35, The death group was127.3±49.45, P<0.001),serum procalcitonin (The survival group was10.60±3.61, The death group was14.8±4.86, P=0.003), APACHEII Score (The survival group was16.28±5.12, The deathgroup was30.6±7.92, P<0.001), antibiotics application time (The survival group was12.15±3.68, The death group was17.91±7.70, P<0.001), and blood system infection(The survival group was33.3%, The death group was66.7%, P=0.048), are differencebetween survival and death groups in patients with septic shock. Of all the abovefactors we conducted Logistic multiple regression analysis, and the result showed thatAPACHEII score OR=1.793(95%CI0.416~6.997, P=0.011), the NT-pro-BNP levelsOR=1.654(95%CI,0.745~5.680, P=0.022), C-reactive protein OR=1.356(95%CI,0.459~5.975, P=0.043), serum procalcitonin OR=1.468(95%CI,0.580~4.765,P=0.048) were independent risks of the death in patients with septic shock. By linearregression analysis, we found the correlation between APACHE II score inNT-pro-BNP levels (r=0.761, P<0.001), C-reactive protein (r=0.615, P=0.04) andprocalcitonin (r=0.571, P=0.008);And the correlation between NT-pro-BNP withC-reactive protein (r=0.765, P <0.001) and procalcitonin (r=0.617, P<0.001) is well;While C-reactive protein and procalcitonin is well correlation (r=0.639, P=0.045).Conclusion: The study found that the plasma NT-pro-BNP levels, C-reactiveprotein and procalcitonin between survival groups and death groups were significantdifference, and well correlated with APACHEII score and clinical mortality in septicshock patients, so these indicators might act as Independent risk factor for death inpatients with septic shock. The plasma NT-pro-BNP, C-reactive protein andprocalcitonin existed linear correlation, which Prompted that there may be a correlationbetween the generation of NT-pro-BNP and the release of inflammatory cytokines inpatients with septic shock, but the The OR value in plasma NT-pro-BNP level betweenthe death group and survival group was most significant，and the correlation betweenNT-pro-BNP level with APACHEII score is best.