Objective: The aim of this study was to evaluate the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality in a large, unselected patient population with severe sepsis and septic shock.
Design And Setting: Prospective observational cohort study about incidence and prognosis of sepsis in 24 intensive care units in Finland (the FINNSEPSIS study).
Patients: A total of 254 patients with severe sepsis or septic shock.
Measurements: After informed consent, the blood tests for NT-proBNP analyses were drawn on the day of admission and 72 hrs thereafter. Patients' demographic data were collected, and intensive care unit and hospital mortality and basic hemodynamic and laboratory data were recorded daily.
Main Results: NT-proBNP levels at admission were significantly higher in hospital nonsurvivors (median, 7908 pg/mL) compared with survivors (median, 3479 pg/mL; p = .002), and the difference remained after 72 hrs (p = .002). The receiver operating characteristic curves of admission and 72-hr NT-proBNP levels for hospital mortality resulted in area under the curve values of 0.631 (95% confidence interval, 0.549-0.712; p = .002) and 0.648 (95% confidence interval, 0.554-0.741; p = .002), respectively. In logistic regression analyses, NT-proBNP values at 72 hrs after inclusion and Simplified Acute Physiology Score for the first 24 hrs were independent predictors of hospital mortality. Pulmonary artery occlusion pressure (p < .001), plasma creatinine clearance (p = .001), platelet count (p = .03), and positive blood culture (p = .04) had an independent effect on first-day NT-proBNP values, whereas after 72 hrs, only plasma creatinine clearance (p < .001) was significant in linear regression analysis.
Conclusion: NT-proBNP values are frequently increased in severe sepsis and septic shock. Values are significantly higher in nonsurvivors than survivors. NT-proBNP on day 3 in the intensive care unit is an independent prognostic marker of mortality in severe sepsis.
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http://dx.doi.org/10.1097/01.CCM.0000261893.72811.0F | DOI Listing |
Ann Intensive Care
January 2025
Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA.
J Am Med Inform Assoc
January 2025
Department of Computer Science, Duke University, Durham, NC 27708, United States.
Objective: Prediction of mortality in intensive care unit (ICU) patients typically relies on black box models (that are unacceptable for use in hospitals) or hand-tuned interpretable models (that might lead to the loss in performance). We aim to bridge the gap between these 2 categories by building on modern interpretable machine learning (ML) techniques to design interpretable mortality risk scores that are as accurate as black boxes.
Material And Methods: We developed a new algorithm, GroupFasterRisk, which has several important benefits: it uses both hard and soft direct sparsity regularization, it incorporates group sparsity to allow more cohesive models, it allows for monotonicity constraint to include domain knowledge, and it produces many equally good models, which allows domain experts to choose among them.
Urol Res Pract
January 2025
Department of Urology, Universitas Sumatera Utara Hospital - Universitas Sumatera Utara, Indonesia.
Improved prostate biopsy procedures have been developed to overcome traditional limitations, aiming to enhance cancer diagnosis accuracy. To assess the existing knowledge of the effectiveness and risks linked to transperineal (TP) vs. transrectal (TR) prostate biopsy.
View Article and Find Full Text PDFEnviron Toxicol
January 2025
Department of Biochemistry, Faculty of Veterinary Medicine, Ataturk University, Erzurum, Turkey.
Sepsis remains the leading cause of multiple-organ injury due to endotoxemia. Astaxanthin (ASTA), widely used in marine aquaculture, has an extraordinary potential for antioxidant and anti-inflammatory activity. Purinergic receptor (e.
View Article and Find Full Text PDFAust Vet J
January 2025
Scone Equine Hospital, 406 Bunnan Road, Scone, New South Wales, Australia.
Introduction: Sepsis is a leading cause of morbidity and mortality in neonatal foals. Administration of appropriate antimicrobials and early aggressive supportive treatment is central to the efficacious treatment of neonatal sepsis and has proven to positively influence outcomes. The primary aim of our study was to evaluate microorganism results and antimicrobial sensitivities of neonatal foals with a positive blood culture submitted to our intensive care unit (ICU) during 2005-2022.
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