老年多器官功能不全综合征患者NT-proBNP水平对预后的影响

目的探讨老年多器官功能不全综合征（MODSE）患者血清氨基末端脑钠肽前体（NT-proBNP）水平变化及其临床意义。方法选择住院的内科MODSE患者55例，在入院24h内对患者进行急性病生理学与长期健康状况评分Ⅱ（APACHEⅡ），同时检测血清NT—proBNP水平，随访1个月，分为存活组（42例）和死亡组（13例）。结果患者APACHEⅡ各分值段血NT-proBNP水平和病死率随APACHEⅡ分值升高而增加。存活组患者APACHEⅡ评分、血NT-proBNP水平均明显低于死亡组。血清NT-proBNP水平和APACHEⅡ评分呈显著正相关（r=0．635，P〈0．001）。血清NT-proBNP水平预测1个月内死亡率的ROC曲线下面积为0．932，以4510．5ng／L为界值，预测死亡敏感性100％、特异性76．2％。APACHEII评分和血清NT-proBNP水平是患者预后的独立危险因素。结论MODSE患者血清NT-proBNP水平与病情相关，随病情严重程度增加，可以作为反映病情及评价预后的指标。

Serum N-terminal pro-brain natriuretic peptide levels on the prognosis of multiple organ dysfunction syndrome in the elderly

Objective To investigate the changes and clinical significance of serum N-terminal pro-brain natri- uretic peptide （NT-proBNP） levels in the elderly patients with multiple organ dysfunction. Methods Fifty-five elderly patients with multiple organ dysfunction were enrolled. The severity of illness score（APACHE Ⅱ score） was determined during the first 24h in the hospital, and at the same time, the levels of serum NT-proBNP were measured. All patients were divided into survival group（n=42） and death group（n=13） according to the results of 1-month fol- low-up. Results Increase in the serum NT-proBNP levels and motality were associated with increase in the APACHE Ⅱ score. The APACHE Ⅱscore and serum NT-proBNP levels of the survival group were significantly lower than those of the death group. There was a positive correlation between the serum NT-proBNP levels and APACHE Ⅱ score（r=0. 635,P（0. 001）. Area under the receiver-operating-characteristic curve of NT-proBNP to predict death within 1 month was 0. 932. A NT-proBNP cut-off value of 4510.5 ng/L showed a sensitivity of 100%0 and a specificity of 76.2 % for predicting death. Logistic regression analysis showed that APACHE Ⅱ score and serum NT-proBNP level were independent risk factors for the prognosis. Conclusion The levels of serum NT-proBNP in the elderly patients with multiple organ dysfunction correlate with the severity of disease. Variation of the serum NT-proBNP levels may be an index to reflect the patient＇s condition and to assess the prognosis of the illness.