目的 探讨年龄分层的血清N末端B型钠尿肽前体(NT-proBNP)对重症监护病房(ICU)患者病死率的预测价值.方法 回顾性分析2011年1月至2012年10月顺序收入解放军第四○一医院ICU 295例患者的临床资料,根据年龄将患者分为＜65岁组(105例)和≥65岁组(190例).记录患者入ICU 24 h内的血清NT-proBNP、红细胞比容(HCT)、降钙素原(PCT)、C-反应蛋白(CRP)、血肌酐(SCr)、肾小球滤过率(eGFR)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和存活概率(PS).以ICU病死率为预测终点.利用受试者工作特征曲线(ROC曲线)分析血清NT-proBNP对预后预测的价值.结果 ①两组患者ICU住院时间,机械通气率,病死率,循环、消化、神经系统及术后患者比例,HCT、PCT、CRP比较差异均无统计学意义(均P＞0.05).≥65岁组男性比例、APACHEⅡ评分、呼吸系统疾病患者比例、NT-proBNP明显高于＜65岁组[男性比例:51.6％比33.0％,x2=9.093,P=0.003; APACHEⅡ评分(分):22.94±8.10比19.44±8.51,Z=-3.259,P=0.001;呼吸系统疾病患者比例:29.47％比17.14％,x2=5.472,P=0.024;NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75)比2 882.00(275.15,6 236.00),Z=-5.514,P=0.000];而PS、多发伤和其他疾病患者比例及eGFR明显低于＜65岁组[PS:59.0(31.5,79.0)％比70.0(40.0,84.0)％,Z=-3.431,P=0.001;多发伤患者比例:0.53％比17.14％,x2=30.987,P=0.000;其他疾病比例:5.79％比13.33％,x2=4.962,P=0.030;eGFR(mL·min-1·1.73 m-2):81.07(45.77,131.80)比95.54(33.64,165.55),Z=-2.214,P=0.027].②＜65岁组NT-proBNP预测病死率的曲线下面积(AUC)[95％可信区间(95％CI)]明显大于≥65岁组及全体患者[0.825(0.738～0.892)比0.664(0.592～0.731)、0.725(0.670～0.775),Z1=-2.835,P1=0.005; Z2=-1.995,P2=0.046].③＜65岁组NT-proBNP临界值(2 882 ng/L)的敏感度(76.10％比64.10％)、特异度(82.35％比67.12％)、阳性预测值(90.0％比75.8％)、阴性预测值(62.2％比53.8％)明显高于≥65岁组NT-proBNP临界值(6 062 ng/L).结论 危重病患者以不同年龄分层界定的NT-proBNP临界值评价病死率较为客观和准确.
目的 探討年齡分層的血清N末耑B型鈉尿肽前體(NT-proBNP)對重癥鑑護病房(ICU)患者病死率的預測價值.方法 迴顧性分析2011年1月至2012年10月順序收入解放軍第四○一醫院ICU 295例患者的臨床資料,根據年齡將患者分為＜65歲組(105例)和≥65歲組(190例).記錄患者入ICU 24 h內的血清NT-proBNP、紅細胞比容(HCT)、降鈣素原(PCT)、C-反應蛋白(CRP)、血肌酐(SCr)、腎小毬濾過率(eGFR)、急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分和存活概率(PS).以ICU病死率為預測終點.利用受試者工作特徵麯線(ROC麯線)分析血清NT-proBNP對預後預測的價值.結果 ①兩組患者ICU住院時間,機械通氣率,病死率,循環、消化、神經繫統及術後患者比例,HCT、PCT、CRP比較差異均無統計學意義(均P＞0.05).≥65歲組男性比例、APACHEⅡ評分、呼吸繫統疾病患者比例、NT-proBNP明顯高于＜65歲組[男性比例:51.6％比33.0％,x2=9.093,P=0.003; APACHEⅡ評分(分):22.94±8.10比19.44±8.51,Z=-3.259,P=0.001;呼吸繫統疾病患者比例:29.47％比17.14％,x2=5.472,P=0.024;NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75)比2 882.00(275.15,6 236.00),Z=-5.514,P=0.000];而PS、多髮傷和其他疾病患者比例及eGFR明顯低于＜65歲組[PS:59.0(31.5,79.0)％比70.0(40.0,84.0)％,Z=-3.431,P=0.001;多髮傷患者比例:0.53％比17.14％,x2=30.987,P=0.000;其他疾病比例:5.79％比13.33％,x2=4.962,P=0.030;eGFR(mL·min-1·1.73 m-2):81.07(45.77,131.80)比95.54(33.64,165.55),Z=-2.214,P=0.027].②＜65歲組NT-proBNP預測病死率的麯線下麵積(AUC)[95％可信區間(95％CI)]明顯大于≥65歲組及全體患者[0.825(0.738～0.892)比0.664(0.592～0.731)、0.725(0.670～0.775),Z1=-2.835,P1=0.005; Z2=-1.995,P2=0.046].③＜65歲組NT-proBNP臨界值(2 882 ng/L)的敏感度(76.10％比64.10％)、特異度(82.35％比67.12％)、暘性預測值(90.0％比75.8％)、陰性預測值(62.2％比53.8％)明顯高于≥65歲組NT-proBNP臨界值(6 062 ng/L).結論 危重病患者以不同年齡分層界定的NT-proBNP臨界值評價病死率較為客觀和準確.
목적 탐토년령분층적혈청N말단B형납뇨태전체(NT-proBNP)대중증감호병방(ICU)환자병사솔적예측개치.방법 회고성분석2011년1월지2012년10월순서수입해방군제사○일의원ICU 295례환자적림상자료,근거년령장환자분위＜65세조(105례)화≥65세조(190례).기록환자입ICU 24 h내적혈청NT-proBNP、홍세포비용(HCT)、강개소원(PCT)、C-반응단백(CRP)、혈기항(SCr)、신소구려과솔(eGFR)、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분화존활개솔(PS).이ICU병사솔위예측종점.이용수시자공작특정곡선(ROC곡선)분석혈청NT-proBNP대예후예측적개치.결과 ①량조환자ICU주원시간,궤계통기솔,병사솔,순배、소화、신경계통급술후환자비례,HCT、PCT、CRP비교차이균무통계학의의(균P＞0.05).≥65세조남성비례、APACHEⅡ평분、호흡계통질병환자비례、NT-proBNP명현고우＜65세조[남성비례:51.6％비33.0％,x2=9.093,P=0.003; APACHEⅡ평분(분):22.94±8.10비19.44±8.51,Z=-3.259,P=0.001;호흡계통질병환자비례:29.47％비17.14％,x2=5.472,P=0.024;NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75)비2 882.00(275.15,6 236.00),Z=-5.514,P=0.000];이PS、다발상화기타질병환자비례급eGFR명현저우＜65세조[PS:59.0(31.5,79.0)％비70.0(40.0,84.0)％,Z=-3.431,P=0.001;다발상환자비례:0.53％비17.14％,x2=30.987,P=0.000;기타질병비례:5.79％비13.33％,x2=4.962,P=0.030;eGFR(mL·min-1·1.73 m-2):81.07(45.77,131.80)비95.54(33.64,165.55),Z=-2.214,P=0.027].②＜65세조NT-proBNP예측병사솔적곡선하면적(AUC)[95％가신구간(95％CI)]명현대우≥65세조급전체환자[0.825(0.738～0.892)비0.664(0.592～0.731)、0.725(0.670～0.775),Z1=-2.835,P1=0.005; Z2=-1.995,P2=0.046].③＜65세조NT-proBNP림계치(2 882 ng/L)적민감도(76.10％비64.10％)、특이도(82.35％비67.12％)、양성예측치(90.0％비75.8％)、음성예측치(62.2％비53.8％)명현고우≥65세조NT-proBNP림계치(6 062 ng/L).결론 위중병환자이불동년령분층계정적NT-proBNP림계치평개병사솔교위객관화준학.
Objective To investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoff value for the mortality in different age groups in critically ill patients.Methods A retrospective study was conducted.295 patients admitted to the intensive care unit (ICU) of 401st Hospital of PLA from January 2011 to October 2012 were divided into two groups according to age [group with age＜65 years old (n=105) and group with age≥ 65 years old (n =190)].The concentrations of serum NT-proBNP,hematocrit (HCT),procalcitonin (PCT),C-reactive protein (CRP),serum creatinine (SCr),estimated glomerular filtration rate (eGFR),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and probability of survival (PS) were recorded within 24 hours.The primary outcome was ICU mortality.Receiver operator characteristic curve (ROC curve) was used to evaluate the value of NT-proBNP for predicting the mortality.Results ① There were no significant differences in the length of stay in ICU,mechanical ventilation rate,the mortality,the incidence of cardiovascular disease,digestive disease,neurologic disease,and the number of patients having received operation,HCT,PCT and CRP between the two groups (all P＞0.05).The percentage of the male,the APACHE Ⅱ score,the percentage of respiratory disease,and NT-proBNP in group with age ≥ 65 years old were higher than those of the group with age ＜ 65 years old [the percentage of the male:51.6％ vs.33.0％,x2=9.093,P=0.003; APACHE Ⅱ score:22.94 ±8.10 vs.19.44 ±8.51,Z=-3.259,P=0.001; the percentage of respiratory disease:29.47％ vs.17.14％,x2=5.472,P=0.024; NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75) vs.2 882.00 (275.15,6 236.00),Z=-5.514,P=0.000]; PS,the percentage of patients having multiple injuries and other diseases and eGFR in group with age ≥65 years old were lower than those of the group with age ＜65 years old [PS:59.0 (31.5,79.0)％ vs.70.0 (40.0,84.0),Z=-3.431,P=0.001; the percentage of multiple injuries:0.53％ vs.17.14％,x2=30.987,P=0.000; the percentage of other disease:5.79％ vs.13.33％,x2=4.962,P=0.030; eGFR (ml·min-1· 1.73 m-2):81.07 (45.77,131.80) vs.95.54 (33.64,165.55),Z=-2.214,P=0.027].② The area under the ROC curve (AUC) [95％ confidence interval (95％ CI)] of NT-proBNP in patients with age＜65 years old was significantly higher than that of group with age≥65 years old and the entire group [0.825(0.738-0.892) vs.0.664 (0.592-0.731) and 0.725 (0.670-0.775),Z1 =-2.835,P1 =0.005; Z2=-1.995,P2=0.046].③ The sensitivity (76.]0％ vs.64.10％),specificity (82.35％ vs.67.12％),positive predictive value (90.0％ vs.75.8％),and negative predictive value (62.2％ vs.53.8％) with cutoff value of NT-proBNP (2 882 ng/L) in group with age ＜65 years old were significantly higher than those with NT-proBNP cutoff value (6 062 ng/L) in group with age ≥ 65 years old.Conclusion NT-proBNP cutoff value in different age groups for the prediction of mortahty in the critically ill patients maybe more objective and accurate.
