Background: Increased plasma levels of N-terminal pro-Brain natriuretic peptide (NT-proBNP) have been identified as predictors of cardiac dysfunction and death in many critical care settings, including congestive heart failure, myocardial infarction, septic shock and severity of cirrhosis. As NT-proBNP has shown to be related to the severity of liver disease, severity of infection and severity of cardiac dysfunction, the aim of the present study was to determine the role of NT-proBNP as a potential predictor of outcome in cirrhotic patients with sepsis.
Methods: This prospective study was conducted at Rajavithi Hospital between January 2015 and Janu- ary 2016. Thirty cirrhotic patients with sepsis from various types and sites of infection were enrolled. Plasma NT- proBNP levels were tested at the time of admission (D1) and on the fifth day of admission (D5). Electrocardio- graphy (n=28) and echocardiography (n=24) were performed to evaluate the baseline cardiac functions. Liver- related morbidities were defined by the development of hepatic encephalopathy, spontaneous bacterial peritonitis, variceal bleeding and/or hepatorenal syndrome during admission.
Results: Thirty cirrhotic patients with sepsis were included. There were 57% male with a median age of 53 years. The mean NT-proBNP levels on D1 (2,889.3 pg/mL vs. 2,240.1 pg/mL; p=0.089), on D5 (2,416.7 pg/mL vs. 1,186.9, p=0.24), and the mean of the difference of NT-proBNP levels between D1-D5 (297.6 pg/mL vs. - 1053.2 pg/mL, p=0.163) were not significantly different between patients who died and those who survived, re- spectively. Although, there was a trend of higher NT-proBNP levels on D1 and D5 found in patients who died. Significant predictors for liver-related morbidities were higher NT-proBNP levels on D1 (4,161.9 pg/mL vs. 1,266.9 pg/mL, p= 0.019), higher NT-proBNP levels on D5 (3,036.1 pg/mL vs. 786.1 pg/mL, p=0.026), higher baseline MELD score (26 ± 7 vs. 18 ± 7, p=0.003), and higher baseline serum creatinine (1.55 ± 0.69 mg/dL vs. 1.07 ± 0.48 mg/dL, p=0.031). According to the echocardiographic parameters, a lower MV E/A ratio and a higher LVEF were significantly associated with liver-related morbidities (1.19 ± 0.38 vs. 0.85 ± 0.27, p=0.019 and 69.13 ± 5.38% vs. 75.28 ± 3.63%, p=0.008, respectively).
Conclusion: Plasma NT-proBNP level did not predict in-hospital mortality in cirrhotic patients with sepsis. However, a higher plasma NT-proBNP level was associated with the development of liver-related morbidi- ties, suggesting it may be a potentially useful marker for early detection or prediction of complications in cirrhotic patients with sepsis.
Key words : N-Terminal Pro-brain natriuretic peptide (NT-proBNP), mortality, sepsis, cirrhosis