血浆B型脑利钠肽联合左室舒张功能障碍对脓毒症休克患者预后的评估
Combination of B-type brain natriuretic peptide with left ventricular diastolic dysfunction for prediction of mortality in the patients with septic shock
目的 探讨血浆B型脑利钠肽(BNP)和二尖瓣舒张早期峰流速/二尖瓣环舒张早期速度比率(E/E')对脓毒症休克患者的预测价值.方法 2012年6月至2013年12月浙江省人民医院重症医学科(ICU)脓毒症休克患者127例,采集患者临床、实验室和生存数据,入ICU 6 h内进行组织多普勒超声检查测定E/E',并留取血标本测定血浆BNP浓度.结果 脓毒症休克患者年龄(59.9±17.3)岁,急性生理与慢性健康评分(APACHEⅡ)为(16.8±5.8),95例(78.4%)患者接受机械通气治疗,其中,28 d和60d病死率分别为36.3%和42.3%.单因素Cox回归分析示,年龄、冠心病、血肌酐、血乳酸、BNP、左室射血分数(LVEF)、E/E'和APACHEⅡ评分与病死预后显著相关(P≤0.05);多因素Cox回归分析示,血乳酸、BNP(x2=9.4,P=0.002)、E/E'(x2 =4.89,P=0.02)和APACHEⅡ评分(x2=10.6,P=0.001)是预测脓毒症休克患者60d病死独立危险因素.ROC分析显示BNP和E/E'预测60 d病死最佳切点分别为338.8 pg/ml和10.8,ROC下面积分别为0.89(敏感度:83.7%;特异度:81.4%)和0.83(敏感度:76.7%;特异度:72.9%).此外,在BNP和临床因素预测脓毒症休克死亡的基础上,E/E'能提供独立额外地预测其60d病死价值(x2=59.3比47.8,P <0.001).结论 血浆BNP和E/E'是预测脓毒症休克患者病死的独立危险因素,联合血浆BNP和E/E'指标能更加准确对脓毒症休克患者生存预后进行危险分层.
更多Objective To evaluate the prognostic value of combination of plasma brain natriuretic peptide(BNP) with the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/E') in the patients with septic shock.Methods From June 2012 to December 2013,127 patients with septic shock were consecutively recruited and underwent trans-thoracic echocardiography examination within 6 h after admission to Intensive Care Unit (ICU),Zhejiang Provincial People's Hospital.Plasma BNP concentration was measured using ELISA method.All Clinical,laboratory,and survival data were prospectively collected.Results Of 127 patients enrolled,mean values for age were (59.9 ± 17.3) years and APACHE Ⅱ score(16.8 ±5.8),respectively.95 patients(74.8%) took mechanical ventilation.28-,60-day mortality rate was 36.3% and 42.3%,respectively.Univariate Cox regression analysis showed that age,coronary artery disease,serum creatinine and lactate,plasma BNP,left ventricular ejection fraction (LVEF),E/E' and APACHE Ⅱ score were significantly (P≤0.05) associated with 60-day mortality.Multivariate analysis revealed that serum lactate,plasma BNP(x2 =9.4,P =0.002),E/E' (x2 =4.89,P =0.02) and APACHE Ⅱ score (x2 =10.6,P =0.001) remained independent predictors for 60-day mortality.ROC curve analysis showed that the optimal plasma BNP and E/E' cutoff values identified were 338.8 pg/ml and 10.8,and the areas under ROC curve were 0.89(sensitivity:83.7%;specificity:81.4%)and 0.83 (sensitivity:76.7%;specificity:72.9%) for 60-day mortality,respectively.In addition to plasma BNP and clinical predictors,the E/E' could provide in independent and incremental prognostic value of 60-day mortality(x2 =59.3 vs 47.8,P < 0.001).Conclusion Plasma BNP and E/E' are independent predictors for 60-day mortality,and combination of plasma BNP and E/E' could improve risk stratification in patients with septic shock.
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