Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Martin-Rodríguez, Francisco; Melero-Guijarro, Laura; Ortega, Guillermo J.; Sanz-García, Áncor; Dios, Teresa de la Torre de; Manzanares, Jesús Álvarez; Conty, José Luis Martín; Villamor, Miguel Ángel Castro; Benito, Juan F Delgado; López-Izquierdo, Raúl

doi:10.1155/2022/5351137

Cited by 3 publications

(2 citation statements)

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“… 27 This study also discovered that the increase in pro-BNP was closely associated with death risk for patients with sepsis, which could be explained by the close relationship between pro-BNP and heart failure. 28 Our study also observed that an increase in creatinine levels in the serum could help to predict the death risk of patients since sepsis causes acute renal injury. Previous studies have indicated that acute renal injury is related to the high mortality rate of sepsis.…”

Section: Discussionsupporting

confidence: 56%

“…Recent studies have found the role of pro-BNP and lactic acid in prognosis of patients with sepsis, supporting the displayed advantages of established models over SOFA score models. 28 , 32 Three variables (respiratory failure, creatinine and total bilirubin) were commonly included in this established model and SOFA score, indicating their significance in death risk prediction in patients with sepsis.…”

Section: Discussionmentioning

confidence: 99%

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Development of a Nomogram for Predicting Mortality Risk in Sepsis Patients During Hospitalization: A Retrospective Study

Lü¹,

Pan²,

Wang³

et al. 2023

IDR

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Purpose We attempted to establish a model for predicting the mortality risk of sepsis patients during hospitalization. Patients and Methods Data on patients with sepsis were collected from a clinical record mining database, who were hospitalized at the Affiliated Dongyang Hospital of Wenzhou Medical University between January 2013 and August 2022. These included patients were divided into modeling and validation groups. In the modeling group, the independent risk factors of death during hospitalization were determined using univariate and multi-variate regression analyses. After stepwise regression analysis (both directions), a nomogram was drawn. The discrimination ability of the model was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, and the GiViTI calibration chart assessed the model calibration. The Decline Curve Analysis (DCA) was performed to evaluate the clinical effectiveness of the prediction model. Among the validation group, the logistic regression model was compared to the models established by the SOFA scoring system, random forest method, and stacking method. Results A total of 1740 subjects were included in this study, 1218 in the modeling population and 522 in the validation population. The results revealed that serum cholinesterase, total bilirubin, respiratory failure, lactic acid, creatinine, and pro-brain natriuretic peptide were the independent risk factors of death. The AUC values in the modeling group and validation group were 0.847 and 0.826. The P values of calibration charts in the two population sets were 0.838 and 0.771. The DCA curves were above the two extreme curves. Moreover, the AUC values of the models established by the SOFA scoring system, random forest method, and stacking method in the validation group were 0.777, 0.827, and 0.832, respectively. Conclusion The nomogram model established by combining multiple risk factors could effectively predict the mortality risk of sepsis patients during hospitalization.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Development of a Nomogram for Predicting Mortality Risk in Sepsis Patients During Hospitalization: A Retrospective Study

Lü¹,

Pan²,

Wang³

et al. 2023

IDR

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Brain natriuretic peptide as a predictive marker of mortality in sepsis: an updated systematic review and meta-analysis

Song,

Fan,

Qiu

et al. 2024

BMC Anesthesiol

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Introduction Early identification of patients with sepsis at high risk of death remains a challenge, and whether brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) has a prognostic effect on patients with sepsis is controversial. Here, we clarified the prognostic value of BNP and NT-proBNP and sought to establish suitable cutoff values and intervals. Methods We searched five databases to identify studies that met the inclusion criteria. The primary outcomes were the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and corresponding 95% credible interval (95% CI) of BNP and NT-proBNP. The secondary outcomes were the sensitivity and specificity of BNP or NT-proBNP in subgroup analyses. Results Forty-seven studies were included in our meta-analysis. The pooled sensitivity of NT-proBNP (0.77 [0.68, 0.84]) was weaker than that of BNP (0.82 [0.76, 0.87]), the pooled specificity of NT-proBNP (0.70 [0.60, 0.77]) was less than that of BNP (0.77 [0.71, 0.82]), and the AUC of BNP (0.87 [0.83–0.89]) was greater than that of NT-proBNP (0.80 (0.76–0.83]). The results of the subgroup analysis showed that the cutoff range of 400–800 pg/mL for BNP had high sensitivity (0.86 [0.74–0.98]) and specificity (0.87 [0.81–0.93]) and was probably the most appropriate cutoff range. Conclusions Elevated levels of BNP and NT-proBNP were significantly related to the mortality of patients with sepsis and had a moderate prognostic value in predicting the mortality of patients with sepsis. In addition, our meta-analysis preliminarily established appropriate cutoff values for BNP and NT-proBNP. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-024-02661-z.

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N-terminal Pro-B-Type Natriuretic Peptide is a Myocardial Biomarker in Pulmonary Sepsis and Septic Shock

Tyurin

Проценко

Kozlov

2022

Vestn. anesteziol. reanimatol.

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The objective: to study changes and prognostic significance of the blood NT-proBNP in the patients with pulmonary sepsis.Subjects and Methods. The study included 34 patients aged 54.5 ± 2.9 years with pulmonary sepsis or septic shock. Lethality in the intensive care unit (ICU) was 47.1%. NT-proBNP, procalcitonin (PCT) levels, blood lactate and hemodynamic parameters were registered on the 1st day (stage 1) and on the 4th-5th day of the ICU stay (stage 2). Hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results: At stage 1, NT-proBNP level was 5,220 [1,380‒17,850] pg/ml, did not decrease (p = 0.726) at stage 2 and amounted to 1,760 [631‒847] pg/ml. At stage 1, NT-proBNP correlated with extravascular lung water index (rho = 0.445; p = 0.038) and systolic pulmonary artery pressure (rho = 0.414; p = 0.023). At stage 2, NT-proBNP correlated with PCT (rho = 0.569; p = 0.003), blood lactate (rho = 0.525; p = 0.001), and mean arterial pressure to norepinephrine dosage ratio (rho = -0.422; p = 0.035). At stage 1, NT-proBNP was no predictor of lethality in the ICU: OR 1.0000; 95% CI 1.0000-1.0001. At stage 2, NT-proBNP > 4,260 pg/ml (sensitivity 87.5%, specificity 94.4%) was a predictor of lethality: OR 1.0004, 95% CI 1.0000-1.0008, p = 0.046 (AUC 0.893, 95% CI 0.732-0.974). Any increase of NT-proBNP level (> 0 pg/ml) between stages 2 and 1 was a predictor of lethality (sensitivity 87.5%, specificity 94.4%): OR 119.0, 95% CI 9.7432‒1,453.4241, p = 0.0002 (AUC 0.903, 95% CI 0.751-0.977).Conclusion: Patients with pulmonary sepsis are characterized by a significant increase of blood NT-proBNP. At stage 1, the biomarker correlated with pulmonary hypertension and moderate pulmonary edema and was no predictor of lethality. At stage 2, NT-proBNP correlated with the indices of infection and sepsis severity (procalcitonin, blood lactate, and mean arterial blood pressure/norepinephrine dosage ratio). At this stage, NT-proBNP levels greater than 4,000 pg/mL and/or any degree of increase in blood levels of the biomarker were both sensitive and specific predictors of a lethal outcome. Specific features of etiopathogenesis of BNP hyperproduction in pulmonary sepsis make it difficult to interpret the elevation of NT-proBNP as an indicator of septic cardiomyopathy but does not reduce its value as a sensitive and specific predictor of lethality.

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Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality

Cited by 3 publications

References 71 publications

Development of a Nomogram for Predicting Mortality Risk in Sepsis Patients During Hospitalization: A Retrospective Study

Development of a Nomogram for Predicting Mortality Risk in Sepsis Patients During Hospitalization: A Retrospective Study

Brain natriuretic peptide as a predictive marker of mortality in sepsis: an updated systematic review and meta-analysis

N-terminal Pro-B-Type Natriuretic Peptide is a Myocardial Biomarker in Pulmonary Sepsis and Septic Shock

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