Natriuretic peptide useful for predicting mortality in patients with sepsis

The B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) cutoff points of 622 pg/mL and 4,000 pg/mL, respectively, are optimal for predicting short-term mortality in patients with sepsis, a study reports.

Researchers conducted a systematic review and meta-analysis. They searched multiple online databases for studies evaluating adult patients with sepsis, severe sepsis, and septic shock with BNP/NT-proBNP levels and short-term mortality (intensive care unit, in-hospital, 28-day or 30-day).

The search yielded 35 studies, with a total of 3,508 patients (median age, 51–71 years; 12–74 percent males; cumulative mortality, 34.2 percent), for inclusion in the meta-analysis. Three studies were conducted in the emergency department, while the rest were conducted in intensive care units. In most studies, BNP/NT-proBNP levels were measured within the first 24 hours after admission.

The average values in survivors and nonsurvivors were used to calculate the receiver operating characteristic curve (ROC) via a parametric regression model. Pooled data showed that a BNP of 622 pg/mL achieved the highest performance for discriminating mortality, with an area under the ROC of 0.766 (95 percent confidence interval [CI], 0.734–0.797). The sensitivity was 69.5 percent, while specificity was 90.7 percent.

Meanwhile, an NT-proBNP of 4,000 pg/mL best discriminated mortality, with an area under the ROC of 0.787 (95 percent CI, 0.766–0.809) and sensitivity and specificity of 72.8 percent and 78.9 percent, respectively.

In prespecified subgroup analyses, BNP/NT-proBNP cutoffs achieved better performance if specimens were obtained within 24 hours of admission in patients with severe sepsis/septic shock, in those enrolled after 2010, and in studies performed in the US and Europe.