Circulating NT-proCNP predicts sepsis in multiple-traumatized patients without traumatic brain injury.
OBJECTIVE
C-type natriuretic peptide (CNP), a member of the natriuretic peptide family, is produced in vascular endothelium. We assessed the accuracy of natriuretic (NT)-proCNP, the N-terminal fragment of the C-type natriuretic peptide precursor, in predicting development of sepsis in multiple-traumatized patients with/without traumatic brain injury verified by computed tomography.


METHODS
Retrospective clinical study.


METHODS
Level II trauma center.


METHODS
Three patient groups were stratified according to computed tomography results: isolated traumatic brain injury (n = 20), multiple-traumatized with traumatic brain injury (n = 26) and multiple-traumatized without traumatic brain injury (n = 26). During 13 days after multiple trauma, 37 (51%) patients developed sepsis.


RESULTS
Circulating plasma NT-proCNP levels were measured daily (days 0-13) in all patients. Without any retrospective stratification of trauma patients, plasma NT-proNCP levels did not differ in septic (n = 37) and nonseptic (n = 35) patients (p = .505). Between days 2 and 6 posttrauma, there was a significant (p = .002) increase of circulating NT-proCNP in multiple-traumatized patients without traumatic brain injury who developed sepsis (n = 19) compared with nonseptic multiple-traumatized patients without traumatic brain injury. Conversely, in septic patients either with traumatic brain injury alone or with multiple trauma and traumatic brain injury, the NT-proCNP showed a trend toward lower levels than in nonseptic patients. Prediction of sepsis (receiver-operating characteristic test) from days 2 to 6 after multiple trauma by NT-proCNP in patients without traumatic brain injury was accurate with an area under the curve of 0.84 +/- 0.03. The optimal cutoff value of 2.3 pmol/L produced sensitivity of 84% to 96% and specificity of 61% to 91% from day 2 to 6 after trauma.


CONCLUSIONS
Our data showed that the levels of circulating NT-proCNP between multiple-traumatized patients without traumatic brain injury who do and do not develop sepsis are distinctly different. Plasma NT-proCNP concentration can potentially serve as an accurate predictor of sepsis in this cohort of patients.
Bahrami
Soheyl
S
Ludwig Boltzmann Institute for Experimental & Clinical Traumatology, Research Centre of AUVA, Vienna, Austria. Soheyl.Bahrami@trauma.lbg.ac.at
Pelinka
Linda
L
Khadem
Anna
A
Maitzen
Sonja
S
Hawa
Gerhard
G
van Griensven
Martijn
M
Redl
Heinz
H
D018806:APACHE; D000328:Adult; D000704:Analysis of Variance; D001317:Austria; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D020098:Natriuretic Peptide, C-Type / Q000097:blood*; D016011:Normal Distribution; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D015996:Survival Rate; D014193:Trauma Centers; D055815:Young Adult
D015415:Biomarkers; D020098:Natriuretic Peptide, C-Type