title: Brain natriuretic peptide for prediction of mortality in patients with sepsis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Early identification of septic patients at high risk of dying remains a challenge. The prognostic role of brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) in septic patients remains controversial. The purpose of this systematic review and meta-analysis was to investigate the value of elevated BNP or NT-proBNP in predicting mortality in septic patients.
  
  
  METHODS
  PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched (up to February 18, 2011). Studies were included if they had prospectively collected data on all-cause mortality in adult septic patients with either plasma BNP or NT-proBNP measurement. Studies that failed to construct a 2 × 2 table of results were excluded. Two authors independently determined the validity of included studies and extracted data.
  
  
  RESULTS
  12 studies with a total of 1,865 patients were included. Elevated natriuretic peptides were significantly associated with increased risk of mortality (odds ratio (OR) 8.65, 95% confidence interval (CI) 4.94 to 15.13, P < 0.00001). The association was consistent for BNP (OR 10.44, 95% CI 4.99 to 21.58, P < 0.00001) and NT-proBNP (OR 6.62, 95% CI 2.68 to 16.34, P < 0.0001). The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 79% (95% CI 75 to 83), 60% (95% CI 57 to 62), 2.27 (95% CI 1.83 to 2.81) and 0.32 (95% CI 0.22 to 0.46), respectively.
  
  
  CONCLUSIONS
  Our results suggested that an elevated BNP or NT-proBNP level may prove to be a powerful predictor of mortality in septic patients. Future larger and more adequately powered prospective studies are warranted to clarify the assay standardization, the optimal cut-off, and the prognostic value of BNPs in conjunction with other biomarkers.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.forename: Youping
authors.initials: Y
authors.lastname: Wu
authors.forename: Lu
authors.initials: L
authors.lastname: Tang
authors.forename: Weimin
authors.initials: W
authors.lastname: Zhu
authors.forename: Feng
authors.initials: F
authors.lastname: Chen
authors.forename: Tao
authors.initials: T
authors.lastname: Xu
authors.forename: Lulong
authors.initials: L
authors.lastname: Bo
authors.forename: Jinbao
authors.initials: J
authors.lastname: Li
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Deng
mesh_terms: D015415:Biomarkers / Q000097:blood; D002986:Clinical Trials as Topic / Q000379:methods / Q000401:mortality; D006801:Humans; D009026:Mortality / Q000639:trends; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain