Brain natriuretic peptide (BNP) and cardiac troponin I(cTnI) for prediction of the prognosis in cancer patients with sepsis

Abstract

Background This study aimed to study the value of brain natriuretic peptide (BNP) and cardiac troponin I(cTnI) for predicting the prognosis in cancer patients with sepsis. Methods A cohort of 233 cancer patients with sepsis admitted to our ICU from January 2017 to October 2020 was included in this retrospective study. BNP and cTnI on the first day (d1) and the third day(d3) after entering ICU, blood lactate (Lac), procalcitonin (PCT), Leucocyte, Sequential Organ failure assessment (SOFA) scores, the incidence of septic shock, acute kidney injury(AKI), acute respiratory failure (ARF) requiring mechanical ventilation(MV) and sepsis-induced myocardial dysfunction(SIMD) within 24 hours of entering ICU, fluid balance in 24hr and 72hr of entering ICU, time of MV, length of stay in ICU ,emergency surgery were collected. According to the 28-day mortality, these patients were divided into the survival group (190 cases) and the death group (43 cases). All the above variables were compared. Results The multiple COX regression analysis of these variables indicated that BNP on d1 and d3, SOFA scores ,72hr fluid balance were independent predictors of the mortality in these patients (P < 0.05); The area under the ROC curve was 0.91 ± 0.01(P < 0.05) for BNP on d3. BNP on d3 at 681.5 pg/mL predicted the mortality with a sensitivity of 91.5% and a specificity of 88.7%. All patients were divided into two groups (BNP on d3 < 681.5 pg/ml or > 681.5 pg/ml), Kaplan-Meier analysis performed on the two groups showed a significant difference in the survival curve (P < 0.05) .There were also significant differences on the comorbidities including shock, AKI, ARF in both groups (P < 0.05). 126 out of 233 patients underwent random bedside echocardiography, and a total of 42 cases developed SIMD with an incidence rate of 33.3% (30.6% in the survival group and 40.9% in the death group). There was no significant difference in the incidence of SIMD between the survival group and the death group (P = 0.23). There was a significant difference between the non-SIMD and the SIMD group for BNP on d1 and d3(P < 0.05). Conclusions BNP was a great predictor for the prognosis of cancer patients with sepsis, while cTnI was not.