N-terminal pro-brain natriuretic peptide as an early prognostic factor in cancer patients developing septic shock.
BACKGROUND
The overall prognosis of critically ill patients with cancer has improved during the past decade. The aim of this study was to identify early prognostic factors of intensive care unit (ICU) mortality in patients with cancer.


METHODS
We designed a prospective, consecutive, observational study over a one-year period. Fifty-one cancer patients with septic shock were enrolled.


RESULTS
The ICU mortality rate was 51% (26 deaths). Among the 45 patients who benefited from transthoracic echocardiography evaluation, 17 showed right ventricular dysfunction, 18 showed left ventricular diastolic dysfunction, 18 showed left ventricular systolic dysfunction, and 11 did not show any cardiac dysfunction. During the first three days of ICU course, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in patients presenting cardiac dysfunctions compared to patients without any cardiac dysfunction. Multivariate analysis discriminated early prognostic factors (within the first 24 hours after the septic shock diagnosis). ICU mortality was independently associated with NT-proBNP levels at day 2 (odds ratio, 1.2; 95% confidence interval, 1.004 to 1.32; p = 0.022). An NT-proBNP level of more than 6,624 pg/ml predicted ICU mortality with a sensitivity of 86%, a specificity of 77%, a positive predictive value of 79%, a negative predictive value of 85%, and an accuracy of 81%.


CONCLUSIONS
We observed that critically ill cancer patients with septic shock have an approximately 50% chance of survival to ICU discharge. NT-proBNP was independently associated with ICU mortality within the first 24 hours. NT-proBNP could be a useful tool for detecting high-risk cancer patients within the first 24 hours after septic shock diagnosis.
Mokart
Djamel
D
Department of Anesthesiology and Intensive Care Unit, Paoli-Calmette Institute, 232 bd Sainte Marguerite, 13273 Marseille Cedex 9, France. mokartd@marseille.fnclcc.fr
Sannini
Antoine
A
Brun
Jean-Paul
JP
Faucher
Marion
M
Blaise
Didier
D
Blache
Jean-Louis
JL
Faucher
Catherine
C
D000368:Aged; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012772:Shock, Septic / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D019210:Troponin I / Q000097:blood
D019210:Troponin I; D020097:Natriuretic Peptide, Brain