engleski

Concentration of B-type natriuretic peptide (BNP) discriminates different stages of septic syndrome

Background. The aim of the study was to examine the concentrations of B-type natriuretic peptide (BNP) in different stages of septic syndrome in surgical intensive care unit (ICU) patients. Methods. 133 ICUpatients were classified into five groups according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) criteria: without infection (52), systemic inflammatory response syndrome (SIRS, 20), sepsis (36), severe sepsis (9) and septic shock (16). BNP concentration was determined in serum with an enzyme-linked immunosorbent assay (Biomedica, Austria). Results. The median of BNP concentrations in patients without infection (685.5 fmol/mL ; 95%CI 568-778) was significantly lower (p<0.05) compared with medians in all other groups of patients: SIRS(969 fmol/mL ; 95%CI 801-1677), sepsis(1048 fmol/mL ; 95%CI 813-1626), severe sepsis (1362 fmol/mL ; 95%CI 673-4326) and septic shock (1504 fmol/mL ; 95%CI 1338-3453). BNP concentrations were significantly lower (p<0.05) in SIRS and sepsis compared with septic shock, suggesting a correlation with the severity of sepsis. Receiver operating characteristic (ROC) analysis showed excellent diagnostic accuracy in differentiating patients without infection and those with septic shock with area under the curve(AUC) 0.932, sensitivity (Se) 93.7%, specificity (Sp) 98.5% and optimal BNP cut-off value above 1135 fmol/mL. ROC analysis between other groups of patients showed good discrimination: without infection-severe sepsis: AUC=0.793, Se=77.8%, Sp=88.5% ; without infection-sepsis: AUC=0.742, Se=68.6%, Sp=73.1% ; SIRSseptic shock: AUC=0.772, Se=93.7, Sp=65.0%. Conclusions. BNP concentrations showed a strong relationship with the severity of sepsis, with most increasein patients with the most severe stages of sepsis: severe sepsis and septic shock.

septic syndrome ; intensive care ; B-type natriuretic peptide

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