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Vallabhajosyula S, Wang Z, Murad MH, et al. Natriuretic Peptides to Predict Short-Term Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis. Mayo Clin Proc Innov Qual Outcomes. 2020;4(1):50-64doi: 10.1016/j.mayocpiqo.2019.10.008.
Vallabhajosyula, S., Wang, Z., Murad, M. H., Vallabhajosyula, S., Sundaragiri, P. R., Kashani, K., Miller, W. L., Jaffe, A. S., & Vallabhajosyula, S. (2020). Natriuretic Peptides to Predict Short-Term Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis. Mayo Clinic proceedings. Innovations, quality & outcomes, 4(1), 50-64. https://doi.org/10.1016/j.mayocpiqo.2019.10.008
Vallabhajosyula, Saarwaani, et al. "Natriuretic Peptides to Predict Short-Term Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis." Mayo Clinic proceedings. Innovations, quality & outcomes vol. 4,1 (2020): 50-64. doi: https://doi.org/10.1016/j.mayocpiqo.2019.10.008
Vallabhajosyula S, Wang Z, Murad MH, Vallabhajosyula S, Sundaragiri PR, Kashani K, Miller WL, Jaffe AS, Vallabhajosyula S. Natriuretic Peptides to Predict Short-Term Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis. Mayo Clin Proc Innov Qual Outcomes. 2020 Jan 08;4(1):50-64. doi: 10.1016/j.mayocpiqo.2019.10.008. eCollection 2020 Feb. PMID: 32055771; PMCID: PMC7011015.
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Mayo Clin Proc Innov Qual Outcomes. 2020 Jan 08;4(1):50-64. doi: 10.1016/j.mayocpiqo.2019.10.008. eCollection 2020 Feb.

Natriuretic Peptides to Predict Short-Term Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis.

Mayo Clinic proceedings. Innovations, quality & outcomes

Saarwaani Vallabhajosyula, Zhen Wang, M Hassan Murad, Shashaank Vallabhajosyula, Pranathi R Sundaragiri, Kianoush Kashani, Wayne L Miller, Allan S Jaffe, Saraschandra Vallabhajosyula

Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
  2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
  3. Division of Preventive, Occupational, and Aerospace Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
  5. Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
  6. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
  7. Division of Clinical Core Laboratory Services, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
  8. Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN.

PMID: 32055771 PMCID: PMC7011015 DOI: 10.1016/j.mayocpiqo.2019.10.008

Abstract

Data are conflicting regarding the optimal cutoffs of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to predict short-term mortality in patients with sepsis. We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus) for English-language reports of studies evaluating adult patients with sepsis, severe sepsis, and septic shock with BNP/NT-proBNP levels and short-term mortality (intensive care unit, in-hospital, 28-day, or 30-day) published from January 1, 2000, to September 5, 2017. The average values in survivors and nonsurvivors were used to estimate the receiver operating characteristic curve (ROC) using a parametric regression model. Thirty-five observational studies (3508 patients) were included (median age, 51-75 years; 12%-74% males; cumulative mortality, 34.2%). A BNP of 622 pg/mL had the greatest discrimination for mortality (sensitivity, 0.695 [95% CI, 0.659-0.729]; specificity, 0.907 [95% CI, 0.810-1.003]; area under the ROC, 0.766 [95% CI, 0.734-0.797]). An NT-proBNP of 4000 pg/mL had the greatest discrimination for mortality (sensitivity, 0.728 [95% CI, 0.703-0.753]; specificity, 0.789 [95% CI, 0.710-0.867]; area under the ROC, 0.787 [95% CI, 0.766-0.809]). In prespecified subgroup analyses, identified BNP/NT-proBNP cutoffs had higher discrimination if specimens were obtained 24 hours or less after admission, in patients with severe sepsis/septic shock, in patients enrolled after 2010, and in studies performed in the United States and Europe. There was inconsistent adjustment for renal function. In this hypothesis-generating analysis, BNP and NT-proBNP cutoffs of 622 pg/mL and 4000 pg/mL optimally predicted short-term mortality in patients with sepsis. The applicability of these results is limited by the heterogeneity of included patient populations.

© 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.

Keywords: AUROC, area under the receiver operating characteristic curve; BNP, B-type natriuretic peptide; NT-proBNP, N-terminal pro-B-type natriuretic peptide; ROC, receiver operating characteristic curve; Sn, sensitivity; Sp, specificity

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