Prognostic Value Of Amino-terminal Pro-brain Natriuretic Peptide Combining APACHE â…¡ Score In Critically Ill Patients Of Emergency Department

Objectives:The present study aimed to test the prognostic value of amino-terminal pro-brain natriuretic peptide combining APACHE II score in critically ill patients of Emergency department.Methods:A total of125patients admitted to the emergency intensive care unit(EICU) of Xiangya hospital Cental-South University, during the period from October2012to March2013with the following data: male(n=80), female(n=45), age from16to84years. Plasma NT-proBNP levels were measured within24h after admission, meanwhile, Simplified Acute Physiology Score II were recorded as well. All patients were classified as cardiac or noncardiac according to their primary diagnosis; and were classified as nonsurvivors or survivors according to the outcome of28days after admission. All data were analysed by SPSS20.0version.Results:1. There were98survivors and27nonsurvivors(mortality21.6%). There was no significant difference of sex and age between both groups(P>0.05). Nonsurvivors had higher APACHE II scores compared with survivors(27[11,38] vs.15[10,31], nonsuvivors vs. survivors, respectively, P<0.01).2. In the entire cohort, plasma NT-proBNP value on admission was1665.91(14.60,15000.00)pg/ml. NT-proBNP levels were significantly higher in patients with primary cardiac diagnosis compared with those in noncardiac patients(3125.45.44[262.85,15000.00] vs. 1271.91[14.60,15000.00], cardiac vs. noncardiac, respectively, P<0.01); Survivors had significantly lower NT-proBNP value than nonsurvivors(1249.44[14.60,15000.00] vs.6428.83[582.17,15000.00], suvivors vs. nonsurvivors, respectively, P<0.01).3. Logistic regression analysis revealed that age (OR,1.051; P=0.032), APACHE II score(OR,1.234; P=0.000)and admission NT-proBNP(OR,1.000;P=0.003) predicted EICU mortality.4. The area under the receiver operating characteristic curve(ROC curve) in predicting EICU mortality was0.852for APACHE II and0.793for admission NT-proBNP. The cutoff point of admission NT-proBNP and APACHE II score that best predicted outcome was2374.40pg/ml and18.5, respectively. In noncardiac patients, respective values were0.884for APACHE II and0.757for NT-proBNP. In cardiac patients, respective values were0.815for APACHE â…¡ and0.960for NT-proBNP.5. All patients were divided into3groups according to the best cutoff point of NT-proBNP and APACHE â…¡ score, mortality and the incidence of ventilator, blood purification and vasopressors between3groups were different. Patients with NT-proBNP>2374.40pg/ml and APACHE â…¡I>18got the highest mortality and the incidence of ventilator, blood purification and vasopressors.Conclusion:1. Elevated NT-proBNP and APACHE â…¡ score represents predictors of poor outcome in critically ill patients of Emergency department. NT-proBNP is slightly weaker compared with APACHE â…¡ score; The prognostic value of NT-proBNP in cardiac patients is better than that in noncardiac patients.2. Combining NT-proBNP and APACHE â…¡ score shows better prognostic value in critically ill patients of Emergency department.