Abstract 12338: N-Terminal Probrain Natriuretic Peptide is a Strong Predictor of Long-Term Mortality in Patients With Severe Sepsis and Septic Shock. Data From the Albumin Italian Outcome Sepsis Study
Background: Myocardial depression is a common finding in severe sepsis, related to hemodynamic, metabolic and structural abnormalities. It is associated with increased morbidity and mortality. Although no pathogenic treatment is available, circulating biomarkers may be helpful for clinical management and early stratification of risk.
Aims: To evaluate the clinical utility of circulating biomarkers of myocardial stress and injury in a large, representative cohort of patients with severe sepsis.
Methods: Blood samples were collected 1, 2 and 7 days after enrolment in 995 patients with severe sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial (NCT00707122). N-terminal proBNP (NT-proBNP) and high sensitivity cardiac troponin T (hs-cTnT) were measured in a central laboratory with an electrochemiluminescent assay (Roche Diagnostics). We evaluated the relations between biomarker concentrations, clinical characteristics, 90-day mortality, and the effect of randomized treatment (albumin vs. crystalloids).
Results: Elevated levels of NT-proBNP (946 [492-1887] ng/L) and hs-cTnT (51 [22-137] ng/L, 85% patients > 14 ng/L, ULN) were measured on day 1. Higher concentrations were found in patients with shock, and were related to disease severity (SOFA and SAPS II scores), hemodynamic disturbances, the need of vasoactive drugs and use of renal replacement therapy. Higher NT-proBNP predicted the incidence of coagulation failure (p<0.0001). There was no effect of randomized treatment on cardiac marker levels or on their interaction with mortality. After adjustment for age, sex, comorbidities, physiological and laboratory variables, SOFA and SAPS II scores, and appropriateness of antibiotic therapy, NT-proBNP (HR [95% CI]= 1.44 [1.24-1.68], p<0.0001), but not hs-cTnT concentrations on day 1, predicted 90-day mortality (39.8% event rate).
Conclusions: Biomarkers of myocardial stress and injury are frequently elevated in patients with severe sepsis or septic shock, and related to physiological variables and disease severity. NT-proBNP is an early and independent predictor of long-term mortality in these patients.
Author Disclosures: S. Masson: Other Research Support; Modest; Reagents provided in kind by Roche Diagnostics. Consultant/Advisory Board; Modest; Roche Diagnostics. P. Caironi: None. C. Fanizza: None. T. Vago: None. S. Carrer: None. A. Caricato: None. P. Fassini: None. M. Romero: None. G. Tognoni: None. L. Gattinoni: None. R. Latini: Research Grant; Modest; Roche Diagnostics. Consultant/Advisory Board; Modest; Roche Diagnostics.
- © 2014 by American Heart Association, Inc.