Key result
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.
Why the study?
Does mid-regional pro-ANP level predict survival in critically ill patients with sepsis?
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.
Answers are grounded in this paper and cite their sources.
May support mid-regional pro-ANP for sepsis risk stratification; hypothesis-generating and requires prospective validation before practice change.
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.
No takes yet. Share an insight, caveat, or question.
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.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: