N-Terminal-Pro Brain Natriuretic Peptide (NT-pro BNP) and Troponin I as prognostic markers of septic cardiomyopathy


Authors: Stachura Peter 1;  Turek Zdeněk 2;  Švábl Miroslav 1;  F. Hausmann Dieter 1
Authors‘ workplace: Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Bayreuth GmbH, Deutschland 1;  KARIM UK v Praze, LF v Hradci Králové a FN Hradec Králové 2
Published in: Anest. intenziv. Med., 24, 2013, č. 3, s. 169-178
Category: Intensive Care Medicine - Original Paper

Overview

Objective:
Cardiac dysfunction might be a considerable factor determining the outcome of critically ill patients. NT-pro BNP is highly predictive for the functional and troponin I for the morphological heart dysfunction in septic, critically ill patients. We compared the sensitivity and specificity of NT-pro BNP and troponin I in septic patients to the outcome markers SOFA score and procalcitonin.

Design:
Prospective, observational trial.

Setting:
Surgical Intensive Care Unit (SICU) at a tertiary care hospital.

Materials and Methods:
The trial criteria were met by 16 survivors and 17 non-survivors with severe sepsis or septic shock. ROC curves analysis was made for seven consecutive days of severe sepsis.

Results:
NT-pro BNP was a significantly better prognostic parameter than other parameters (AUC on day 3 = 0.850, cut-off value ≤ 3910 pg/ml) from the third day of severe sepsis. The highest AUC of NT-pro BNP was measured on day 4 (AUC = 0.878) with sensitivity of 100.0% (95% CI 66.4–100.0) and specificity of 80.0% (95% CI 44.4–97.5) by cut-off value ≤ 5 473 pg/ml. Troponin I showed insufficient results in the first two days of severe sepsis with continuous improvement in the next five observed days. The highest AUC was measured on day 4 (AUC = 0.811). The sensitivity of the best cut-off value of troponin I(≤ 0.1 ng/ml) on day 4 was 100.0% (95% CI 66.4–100.0) and specificity 70% (95% CI 34.8–93.3). Procalcitonin was significant at the beginning of severe sepsis only. The best AUC for procalcitonin was measured on day 1 (0.761). SOFA score correlated with the outcome of critically ill septic patients from day 3 and reached the best values on day 6 (AUC = 0.795).

Conclusions:
NT-pro BNP values higher than 3910 pg/mland positive troponin I values in septic patients over 65 years taken on day 3 could be an early marker of risk in patients with myocardial dysfunction. Continuously rising values of NT-pro BNP and higher levels of troponin I during severe sepsis are helpful prognostic markers, superior to other predictors of outcome. Rising values of NT-proBNP and troponin I need diagnostic precision and targeted therapy of septic myocardial dysfunction.

Keywords:
natriuretic peptides – cardiac troponins – septic cardiomyopathy – diagnosis – prognosis


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Anaesthesiology, Resuscitation and Inten Intensive Care Medicine

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