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  • Title: [Combination of B-type brain natriuretic peptide with left ventricular diastolic dysfunction for prediction of mortality in the patients with septic shock].
    Author: Hu BC, Wang YJ, Ge WD, Li FZ, Sun RH.
    Journal: Zhonghua Yi Xue Za Zhi; 2016 Aug 02; 96(29):2295-300. PubMed ID: 27524184.
    Abstract:
    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(χ(2)=9.4, P=0.002) , E/E'(χ(2)=4.89, P=0.02) and APACHE Ⅱ score(χ(2)=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(χ(2)=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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