摘要
目的探讨B型利钠肽（BNP）浓度是否预测急诊非心源性危重患者的28d病死率。方法测量255例急诊室非心源性危重患者血中BNP浓度，并记录各项化验指标和临床生理指标。随访28d患者是否存活，进一步分析入选时血BNP水平与28d病死率的关系。结果28d共有71例死亡，死亡组患者的血BNP浓度中位数水平明显高于存活组（326．0ng／L比50．9ng／L，P〈0．001），BNP水平预测28d病死率的ROE曲线下面积为0．825，血BNP预测患者病死率的最佳界值点是114．0ng／L，血BNP〉114．0．g／L（RR7．268，95％CI3．864～13．672）和急性生理学及慢性健康状况评分（APACHE）Ⅱ评分〉20（RR3．330，95％CI1．815～6．109）是预测患者28d病死率的独立危险因素。结论血BNP水平是预测急诊非心源性危重患者28d病死率的独立指标，应用BNP预测危重患者病死率的能力优于急诊室常用的快速急性生理学评分与快速急诊医学评分系统，与经典的APACHEⅡ评分十分相近。
Objective B-type natriuretic peptide（BNP） have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department （ ED ）. Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of smrvivors （326. 0 ng/L versus 50. 9 ng/L,P 〈 0. 001 ）. The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis （Cox-regression） , a BNP concentration greater than 114. 0 ng/L（ RR 7. 268, 95% CI 3. 864-13. 672） and an Acute Physiology and Chronic Health Evaluation Ⅱ （ APACHE Ⅱ ） scores greater than 20 （ RR 3. 330, 95% CI 1. 815- 6. 109）were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve （ AUC ） of O. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score （RAPS） , Rapid Emergency Medicine Score （HEMS） and APACHE Ⅱ score.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2009年第7期575-578,共4页
Chinese Journal of Internal Medicine
关键词
利钠肽
B型
危重病
预后
Natriuretic peptide,B-type
Critical illness
Prognosis
