title: N-terminal pro-brain natriuretic peptide and cardiac troponin I for the prognostic utility in elderly patients with severe sepsis or septic shock in intensive care unit: A retrospective study.
abstract: BACKGROUND
  Using biomarkers to predict mortality in patient with severe sepsis or septic shock is of importance, as these patients frequently have high mortality and unsatisfied outcome. N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) play extremely important roles in prognostic value in the mortality of severe sepsis and septic shock.
  
  
  OBJECTIVE
  The present study was retrospectively designed to evaluate the predicting mortality of NT-proBNP and cTnI in elderly patients with severe sepsis or septic shock administered in the intensive care unit (ICU) and also to evaluate whether the predicting ability of Acute Physiology and Chronic Health Evaluation II (APACHE-II) score or C-reactive protein (CRP) was increased in combination with the biomarkers.
  
  
  METHODS
  A cohort of 430 patients (aged ≥65 years) with severe sepsis or septic shock admitted to our ICU between October 2011 and December 2013 was included in the study. Patient data including clinical, laboratory, and survival and mortality were collected. All patients were examined with NT-proBNP, cTnI, CRP, and APACHE-II score and were categorized as the survived and deceased groups according to the outcome 30 days after ICU treatment.
  
  
  RESULTS
  The levels of NT-proBNP and cTnI (P < .01) or CRP (P < .05) were significantly higher in the deceased group than those in the survived group. The predicting mortality of APACHE-II score alone was low but largely improved, when it was combined with both NT-proBNP and cTnI (P < .05).
  
  
  CONCLUSIONS
  The alteration of NT-proBNP and cTnI levels strongly predicated the ICU prognosis in elderly patients with severe sepsis or septic shock. N-terminal pro-brain natriuretic peptide and cTnI were superior to CRP in predicting mortality. The predicting ability of APACHE-II score was improved only when combined with NT-proBNP and cTnI.
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China. Electronic address: chh0426@163.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, Second Hospital Affiliated to Hebei Medical University, Shijiazhuang, Hebei Province, China.
authors.forename: Wei-Ze
authors.initials: WZ
authors.lastname: Fan
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China. Electronic address: shchw9061@163.com.
authors.forename: Sheng-Chi
authors.initials: SC
authors.lastname: Wang
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China.
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Liu
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China.
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Zang
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China.
authors.forename: Li-Zhong
authors.initials: LZ
authors.lastname: Wang
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China.
authors.forename: Hong-Juan
authors.initials: HJ
authors.lastname: Liu
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China.
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Shen
authors.affiliation: Intensive Care Unit, Shijiazhuang First Hospital, Shijiazhuang, Hebei Province, China.
authors.forename: Shao-Qing
authors.initials: SQ
authors.lastname: Liang
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: C-reactive protein (CRP); Cardiac troponin I (cTnI); ICU; N-terminal pro B type natriuretic peptide (NT-proBNP); Septic shock; Severe sepsis