Mid-regional pro-atrial natriuretic peptide levels predicted ICU mortality in sepsis patients with an area under the curve of 0.88, performing similarly to the APACHE II score.
Observational (n=101)
No
Does mid-regional pro-ANP level predict survival in critically ill patients with sepsis?
Mid-regional pro-ANP is a strong prognostic marker for survival in sepsis patients, performing similarly to the APACHE II score and better than standard biomarkers like procalcitonin and CRP.
Effect estimate: AUC 0.88 (95% CI 0.77-0.95)
Absolute Event Rate: 0.88% vs 0.86%
p-value: p=0.79
INTRODUCTION: Additional biomarkers in sepsis are needed to tackle the challenges of determining prognosis and optimizing selection of high-risk patients for application of therapy. In the present study, conducted in a cohort of medical intensive care unit patients, our aim was to compare the prognostic value of mid-regional pro-atrial natriuretic peptide (ANP) levels with those of other biomarkers and physiological scores. METHODS: Blood samples obtained in a prospective observational study conducted in 101 consecutive critically ill patients admitted to the intensive care unit were analyzed. The prognostic value of pro-ANP levels was compared with that of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and with those of various biomarkers (i.e. C-reactive protein, IL-6 and procalcitonin). Mid-regional pro-ANP was detected in EDTA plasma from all patients using a new sandwich immunoassay. RESULTS: On admission, 53 patients had sepsis, severe sepsis, or septic shock, and 68 had systemic inflammatory response syndrome. The median pro-ANP value in the survivors was 194 pmol/l (range 20-2000 pmol/l), which was significantly lower than in the nonsurvivors (median 853.0 pmol/l, range 100-2000 pmol/l; P < 0.001). On the day of admission, pro-ANP levels, but not levels of other biomarkers, were significantly higher in non-surviving corrected than in surviving corrected sepsis patients (P = 0.001). In a receiver operating characteristic curve analysis for the survival of patients with sepsis, the area under the curve (AUC) for pro-ANP was 0.88, which was significantly greater than the AUCs for procalcitonin and C-reactive protein, and similar to the AUC for the APACHE II score. CONCLUSION: Pro-ANP appears to be a valuable tool for individual risk assessment in sepsis patients and for stratification of high-risk patients in future intervention trials. Further studies are needed to validate our results.
Morgenthaler et al. (2004) conducted an observational in Sepsis and critical illness (n=101). Mid-regional pro-atrial natriuretic peptide (pro-ANP) measurement vs. APACHE II score and other biomarkers (PCT, CRP, IL-6) was evaluated on Area under the receiver operating characteristic curve (AUC) for predicting death in the ICU among patients with sepsis (AUC 0.88, 95% CI 0.77-0.95, p=0.79). Mid-regional pro-atrial natriuretic peptide levels predicted ICU mortality in sepsis patients with an area under the curve of 0.88, performing similarly to the APACHE II score.