중증 패혈증 및 패혈쇼크 환자의 예후 예측 인자로서 N-terminal pro-brain type natriuretic peptide의 유용성 (N-terminal Pro-Brain-type Natriuretic Peptide as a Prognostic Factor in Severe Sepsis and Septic Shock)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 23권 / 6호 / 853 ~ 861페이지
· 저자명 : 배광수, 김규석, 이재혁, 이중의, 조유환, 박현미

초록

Purpose: This study was performed to evaluate whether Nterminal pro-brain-type natriuretic peptide (NT-proBNP)could predict 28-day mortality in patients with severe sepsis and septic shock.
Methods: We performed a retrospective analysis of prospectively collected data from patients with severe sepsis and septic shock. Patients' demographic data, comorbidities,blood test results (including NT-proBNP concentration),and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and nonsurvivors. NT-proBNP levels were categorized into quartiles by their concentration (≤600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml). Multivariate Cox proportional hazard regression analysis was performed to identify the predictors of mortality during a 28-day follow-up period.
Results: Out of 349 patients, 117(33.5%) died. NT-proBNP concentrations were significantly higher in nonsurvivors compared to survivors (median 4,630 [IQR, 1,876-10,582]vs. 1,552 [IQR, 440-4,064] pg/ml, respectively, p<0.01).
The mortality rate increased with increasing NT-proBNP concentrations; patients with NT-proBNP ≤600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml were 12.9%,26.1%, 39.8%, and 51.1%, respectively. By Cox proportional hazards analysis, compared to patients with the lowest NT-proBNP levels (≤600 pg/ml), patients in groups with higher NT-proBNP levels were more associated with 28-day mortality; 601 to 2,000 pg/ml (hazard ratio [HR], 1.15;95% CI, 0.50-2.63); 2,001 to 6,000 pg/ml (HR, 2.10; 95%CI, 1.05-4.81); >600 pg/ml (HR, 2.30; 95% CI, 1.15-6.14).
Conclusion: NT-proBNP is an independent prognostic factor for 28-day mortality in patients with severe sepsis and septic shock.

영어초록

Purpose: This study was performed to evaluate whether Nterminal pro-brain-type natriuretic peptide (NT-proBNP)could predict 28-day mortality in patients with severe sepsis and septic shock.
Methods: We performed a retrospective analysis of prospectively collected data from patients with severe sepsis and septic shock. Patients' demographic data, comorbidities,blood test results (including NT-proBNP concentration),and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared between 28-day survivors and nonsurvivors. NT-proBNP levels were categorized into quartiles by their concentration (≤600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml). Multivariate Cox proportional hazard regression analysis was performed to identify the predictors of mortality during a 28-day follow-up period.
Results: Out of 349 patients, 117(33.5%) died. NT-proBNP concentrations were significantly higher in nonsurvivors compared to survivors (median 4,630 [IQR, 1,876-10,582]vs. 1,552 [IQR, 440-4,064] pg/ml, respectively, p<0.01).
The mortality rate increased with increasing NT-proBNP concentrations; patients with NT-proBNP ≤600, 601 to 2,000, 2,001 to 6,000, and >6,000 pg/ml were 12.9%,26.1%, 39.8%, and 51.1%, respectively. By Cox proportional hazards analysis, compared to patients with the lowest NT-proBNP levels (≤600 pg/ml), patients in groups with higher NT-proBNP levels were more associated with 28-day mortality; 601 to 2,000 pg/ml (hazard ratio [HR], 1.15;95% CI, 0.50-2.63); 2,001 to 6,000 pg/ml (HR, 2.10; 95%CI, 1.05-4.81); >600 pg/ml (HR, 2.30; 95% CI, 1.15-6.14).
Conclusion: NT-proBNP is an independent prognostic factor for 28-day mortality in patients with severe sepsis and septic shock.

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