Artmış inflamasyonda NT-PROBNP'nin prognostik öneminin retrospektif incelenmesi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Beyin natriüretik peptid (BNP), kardiyovasküler homeostazisinde önemli rol oynamaktadır. Natriüretik, diüretik ve vazodilatör etkileri iyi bilinmektedir. BNP'nin inaktif metaboliti olan NT-proBNP kardiyovasküler hastalıklarda önemli bir biyobelirteç olup; klinik pratikte tanıda ve tedavi takibinde yaygın bir şekilde kullanılmaktadır. Artmış inflamasyonda, özellikle sepsiste mortalite belirteci olduğu birçok çalışmada ifade edilmektedir. Buna karşılık, steril inflamasyondaki etkisi net bilinmemektedir. Ayrıca, artmış inflamasyonda N-terminal proBNP (NT-proBNP)'nin mortalite açısından takipte kullanımı için literatürde yeterli çalışma bulunmamaktadır. Bu çalışmanın amacı, NT-proBNP'nin artmış inflamasyonda mortalite ile ilişkisini göstermek ve NT-proBNP'nin zamansal değişiminin de diğer belirteçlere göre mortalitedeki rolünü incelemektir. Gereç ve Yöntem: Ocak 2015- Mayıs 2020 yılları arasında Ege Üniversitesi Tıp Fakültesi İç Hastalıkları Yoğun Bakım Ünitesine artmış inflamasyon nedeniyle başvuran 231 hasta, retrospektif olarak incelendi. Hastalar ölenler ve yaşayanlar olmak üzere iki gruba ayrıldı. Hastaların demografik özellikleri, komorbiditeleri, yatış esnasında uygulanan tedavileri, yeni gelişen kalp yetmezliği ve böbrek yetmezliği, laboratuvar verileri, Sequential Organ Failure Assessment (SOFA) ve Sistemik İnflamatuvar Cevap Sendromu (SIRS) skorları dosya kayıtlarından elde edildi. NT-proBNP'yi de içeren laboratuvar verilerinin zamansal değişimleri de değerlendirildi. Tek ve çok değişkenli lojistik regresyon analizleri ile NT-proBNP'nin zamansal değişiminin hastane içi mortalite ile ilişkisi incelendi. Bulgular: 231 hastanın %55'i kadın cinsiyette ve hastaların yaş ortancası medyan 41 idi. Yaşayan ve ölen gruplar arasında, bazal değerler incelendiğinde; yeni gelişen kalp ve böbrek yetmezliği, inotrop ve hemodiyaliz ihtiyacı olması ölen grupta daha yüksekti (p<0,05). Ayrıca bazal NT-proBNP, ferritin ve laktat düzeyleri de ölen grupta daha yüksek olarak tespit edilmiştir (p<0,05). NT-proBNP ve ferritin, albümin, CRP, prokalsitonin gibi inflamatuvar belirteçlerin zamansal değişimi mortal grupta istatistiksel olarak daha anlamlı izlenmiştir (p<0,05). Tek değişkenli lojistik regresyon analizinde NT-proBNP (Odds Oranı (OO): 34,5 %95 Güven Aralığı (GA): 11,3-105,2; p<0,001) mortalite riskini arttırmıştır. Çok değişkenli lojistik regresyon analizinde de NT-proBNP (OO:32,3 %95 GA 3,1-338,0; p=0,004) mortalite açısından anlamlıdır. Receiver Operating Characteristics (ROC) analizinde %75 sensitivite %56 spesifite ile mortalite için NT-proBNP'nin kestirim (cutoff) değeri 1058 ng/L olarak tespit edilmiştir. Sonuç: Artmış inflamasyonda gerek bazal NT-proBNP düzeyi gerekse zamansal NT-proBNP değişimlerinin mortalite ile ilişkili olabileceği gösterilmiştir. Ayrıca NT-proBNP'nin zamansal değişiminin mortalite ilişkisi, SOFA skorunun da yer aldığı diğer mortalite belirteçlerinden bağımsız olarak gerçekleşmektedir
Introduction: Brain natriuretic peptide (BNP) plays a pivotal role in cardiovascular homeostasis. Natriuretic, diuretic and vasodilator effects are well-known. NT-proBNP, the inactive metabolite of BNP, is an important biomarker in cardiovascular diseases. It is widely used in clinical practice in diagnosis and treatment of heart failure at the follow-up. It is stated in many studies that NT-proBNP is a mortality marker in hyperinflammation, especially sepsis. In contrast, its effect on sterile inflammation remains unkonwn. In addition, there are not enough studies in the literature for the use of N-teminal proBNP (NT-proBNP) in the mortality of hyperinflammation at the follow-up. The present study aims to show the relationship of NT-proBNP with mortality in hyperinflammation and to examine the role of temporal variation of NT-proBNP in mortality compared to other biomarkers. Materials and Methods: Between January 2015 and May 2020, 231 patients who applied to Ege University Medical Faculty Internal Diseases Intensive Care Unit due to invreased inflammation were retrospectively analyzed. Patients were divided into two groups as non-survivor and survivor. Demographic characteristics, comorbidities, treatments applied during hospitalization, newly developed heart failure and kidney failure, laboratory data, Sequential Organ Failure Assessment (SOFA) and Systemic Inflammatory Response Syndrome (SIRS) scores were obtained from the file records of the patients. Temporal variations of laboratory data, including NT-proBNP, were also evaluated. Univariate and multivariate logistic regression analyzes were performed between the temporal variation of NT-proBNP and in-hospital mortality. Results: Of the 231 patients, 55% were female and the median age of the patients was 41. When basal values are examined between non-survior and survivor groups; newly developed heart and kidney failure, need for inotropic and hemodialysis were higher in the non-survivor group (p<0.05). In addition, basal NT-proBNP, ferritin and lactate levels were also found to be higher in the non-survivor group (p<0.05). The temporal changes of inflammatory markers such as NT-proBNP and ferritin, albumin, CRP, and procalcitonin were statistically more significant in the non-survivor group (p<0.05). In univariate logistic regression analysis, NT-proBNP (Odds Ratio (OR): 34.5 95% Confidence Interval (CI): 11.3-105.2; p<0.001) increased the risk of mortality. In the multivariate logistic regression analysis, NT-proBNP (OR:32.3 95% CI 3.1-338.0; p=0.004) was significant in terms of mortality. In the Receiver Operating Characteristics (ROC) analysis, the cutoff value of NT-proBNP for mortality was determined as 1058 ng/L with 75% sensitivity and 56% specificity. Conclusion: It has been shown that both basal NT-proBNP levels and temporal NT-proBNP changes in hyperinflammation may be associated with mortality. In addition, the temporal variation of NT-proBNP correlates with mortality independently of other mortality markers, including the SOFA score.
Introduction: Brain natriuretic peptide (BNP) plays a pivotal role in cardiovascular homeostasis. Natriuretic, diuretic and vasodilator effects are well-known. NT-proBNP, the inactive metabolite of BNP, is an important biomarker in cardiovascular diseases. It is widely used in clinical practice in diagnosis and treatment of heart failure at the follow-up. It is stated in many studies that NT-proBNP is a mortality marker in hyperinflammation, especially sepsis. In contrast, its effect on sterile inflammation remains unkonwn. In addition, there are not enough studies in the literature for the use of N-teminal proBNP (NT-proBNP) in the mortality of hyperinflammation at the follow-up. The present study aims to show the relationship of NT-proBNP with mortality in hyperinflammation and to examine the role of temporal variation of NT-proBNP in mortality compared to other biomarkers. Materials and Methods: Between January 2015 and May 2020, 231 patients who applied to Ege University Medical Faculty Internal Diseases Intensive Care Unit due to invreased inflammation were retrospectively analyzed. Patients were divided into two groups as non-survivor and survivor. Demographic characteristics, comorbidities, treatments applied during hospitalization, newly developed heart failure and kidney failure, laboratory data, Sequential Organ Failure Assessment (SOFA) and Systemic Inflammatory Response Syndrome (SIRS) scores were obtained from the file records of the patients. Temporal variations of laboratory data, including NT-proBNP, were also evaluated. Univariate and multivariate logistic regression analyzes were performed between the temporal variation of NT-proBNP and in-hospital mortality. Results: Of the 231 patients, 55% were female and the median age of the patients was 41. When basal values are examined between non-survior and survivor groups; newly developed heart and kidney failure, need for inotropic and hemodialysis were higher in the non-survivor group (p<0.05). In addition, basal NT-proBNP, ferritin and lactate levels were also found to be higher in the non-survivor group (p<0.05). The temporal changes of inflammatory markers such as NT-proBNP and ferritin, albumin, CRP, and procalcitonin were statistically more significant in the non-survivor group (p<0.05). In univariate logistic regression analysis, NT-proBNP (Odds Ratio (OR): 34.5 95% Confidence Interval (CI): 11.3-105.2; p<0.001) increased the risk of mortality. In the multivariate logistic regression analysis, NT-proBNP (OR:32.3 95% CI 3.1-338.0; p=0.004) was significant in terms of mortality. In the Receiver Operating Characteristics (ROC) analysis, the cutoff value of NT-proBNP for mortality was determined as 1058 ng/L with 75% sensitivity and 56% specificity. Conclusion: It has been shown that both basal NT-proBNP levels and temporal NT-proBNP changes in hyperinflammation may be associated with mortality. In addition, the temporal variation of NT-proBNP correlates with mortality independently of other mortality markers, including the SOFA score.
Açıklama
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
