Cardiac Troponin and Brain Natriuretic Peptide: Prediction of Mortality Among Septic Pts
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- Category: Vol. 78, June 2010
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Cardiac Troponin and Brain Natriuretic Peptide: Prediction of Mortality Among Septic Pts,KHALED HUSSEIN, AMR EL HADIDY, MOHAMAD ASHRAF, HOSAM MOWAFY and NORA ISMAIL
Abstract
Background: Severe sepsis and septic shock are life-threatening illness that results in catastrophic morbidity or mortality in case of delayed or incorrect treatment. The commonest presentation among them is cardiovascular insta-bility.
Brain Natriuretic peptide (BNP) and cardiac troponin (cTn-I) are promising markers for predicting myocardial affection in septic patients (pts).
Objective: This study was intended to analyze the eleva-tions of BNP and cTn-I in septic pts and their ability to predict mortality.
Methods: A total number of 43 patients (pts) diagnosed to have various degrees of sepsis admitted to Critical Care Department at Cairo University Hospital from October 2007 to February 2009 were recruited in the study. They were classified into group I 23 pts with severe sepsis & group II 20 pts with septic shock. All pts were subjected to APACHE II, MODS, SOFA, O/A and day 2, echocardiography O/A, together with BNP and cTn-I sampling O/A, and day 2.
Results: There was a statistically significant higher BNP level at day 2 than O/A in group II (p=0.012). BNP at day 2 was significantly higher in group II than group I (p=0.004). cTn-I in day 2 was higher in group II than group I. (p=<0.001). The overall mortality among our pts (both groups) was 66.7% (28 out of 43 patients). Eighteen of 20 (90%) in group II Vs. 10 of 23 (43.5%) in group I with significant p value (0.001).
Surgical patients have a significantly higher mortality than medical patients (p=0.037). Non-survivors have signifi-cantly higher number of affected organs with APACHE, SOFA & MODS compared to survivors; p<0.001 O/A & day 2. BNP O/A >75pg/ml (cut off value) by Receiver Operating Curve (ROC) had a sensitivity of 64% and specificity of 60% to predict mortality, cTn I O/A >0.4mcg/L (cut of value) had a sensitivity of 18% and 100 % specificity in predicting mortality and combining both BNP and cTn-I 0/A we can obtain 82% sensitivity and 100% specificity to predict mortality.
Whereas at day 2, BNP >210pg/ml had a sensitivity 38% and specificity 93% to predict mortality, cTn-I >0.4mcg/L had a sensitivity of 17% and specificity 93% to predict mortality and combining both measurements will be sensitivity 55% and specificity 93%, will be less valuable than the combination O/A.
Conclusion: Combining BNP and Cardiac troponin has higher sensitivity and specificity than each of them in predicting mortality among pts with severe sepsis and septic shock especially O/A.