Key result
In patients with resolving sepsis, an initial BNP level > 500 pg/mL was not significantly associated with increased in-hospital mortality after adjusting for ejection fraction and glomerular filtration rate (RR 1.0).
Cohort (n=487)
Relative Risk: 1 (95% CI 0.7–1.5)
Elevated BNP levels on admission are associated with increased in-hospital mortality and longer hospital length of stay in patients with resolving sepsis.
Does not support BNP-guided mortality risk stratification in sepsis; leaves open whether unadjusted elevations reflect confounding in observational cohorts.
BACKGROUND: B-type natriuretic peptide (BNP) is a hormone secreted by cardiomyocytes in response to myocardial ischemia, increased ventricular wall tension, and overload. BNP is utilized as a diagnostic and prognostic marker in congested heart failure (CHF). Its prognostic value in sepsis is unknown. The aim of this study is to determine if BNP correlates with increased in-hospital mortality for septic patients. METHODS: This was a retrospective study of 505 patients admitted for sepsis or severe sepsis or septic shock during the period of January 2013 and August 2014. Patients that received > 3 L of intravenous fluids on presentation were included. Intensive care unit length of stay (ICULOS), hospital length of stay (HLOS) and in-hospital mortality were measured. Mean BNP level was calculated and compared to ICULOS and HLOS and in-hospital mortality. Controlled variables included ejection fraction (measured by echocardiogram within 6 months of presentation), glomerular filtration rate (calculated by Cockroft-Gault equation), patient demographics, and lactic acid trends. Exclusion criteria were no echocardiogram within 6 months of admission, no BNP levels on admission, and no repeat lactate or rising lactate levels within 24 h to indicate worsening sepsis. RESULTS: Patients' mean BNP with in-hospital mortality was 908 pg/mL as compared to mean BNP of 678 pg/mL in survivors. T-test comparisons were statistically significant (P = 0.0375). The Kaplan-Meier curve for BNP as a predictor for in-hospital mortality showed that for the first 25 days, patients with BNP higher than 500 pg/mL had a higher mortality than patients with BNP lower than 500 pg/mL. When comparing HLOS, there is a statistically significant correlation (P = 0.0046). A similar scatter plot was prepared for ICULOS which showed there was a weak positive correlation (r = 0.199). CONCLUSION: Septic patients with in-hospital mortality had an average BNP of 908 pg/mL and statistically significant higher HLOS.
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Singh et al. (2017) conducted a cohort in Resolving sepsis (n=487). BNP > 500 pg/mL vs. BNP <= 500 pg/mL was evaluated on In-hospital mortality (adjusted for EF and GFR) (RR 1.0, 95% CI 0.7-1.5). In patients with resolving sepsis, an initial BNP level > 500 pg/mL was not significantly associated with increased in-hospital mortality after adjusting for ejection fraction and glomerular filtration rate (RR 1.0).
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