Prognostic valule of vasoactive drug score, NT-proBNP, and blood lactate level at 6 h post-admission in adult sepsis patients:A single-center, retrospective study

Abstract

Background

Sepsis is a prevalent and critical condition triggered by an exaggerated immune response to specific infectious agents. The classification of the severity of sepsis plays a fundamental role in early identification and structured management, aiding in the prediction of increased risk of mortality. Despite the utilization of numerous biomarkers in sepsis diagnosis and treatment guidance, the early identification and prediction of sepsis still pose significant challenges.

Objective

To assess the prognostic value of vasoactive-inotropic score (VIS), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and 6 h blood lactate after admission in adult sepsis patients.

Methods

177 adult sepsis patients were enrolled in a cross-sectional study. Based on their 28-day outcome upon admission, patients were divided into a death group (n = 52) and a survival group (n = 125). Clinical data from both groups were collected. Univariate analysis and binary logistic regression were employed to identify independent risk factors for poor prognosis in adult sepsis patients. Receiver operating characteristic curve (ROC) analysis was performed to determine the predictive value of VIS, NT-proBNP, and blood lactate level at 6 h after admission for adult sepsis patients. Kaplan-Meier method was utilized to analyze the relationship between VIS, NT-proBNP, blood lactate level at 6 h after admission, and survival prognosis among adult sepsis patients.

Results

1. VIS (OR: 7.117; 95 % CI: 1.648–30.738; P = 0.009), NT-proBNP (OR: 1.296; 95 % CI: 1.026–1.637; P = 0.030), SOFA score (OR:1.232; 95 % CI: 1.031–1.473; P = 0. 02) and blood lactate at 6 h after admission (OR: 3.484; 95 % CI: l.416–8.573; p = 0.007) were independent risk factors for poor prognosis of adult sepsis. 2. VIS, NT-proBNP, and blood lactate at 6 h after admission were positively correlated with SOFA scores (r = 0 0.255, 0.388, and 0.l89 respectively, P < 0.05). 3. ROC curve analysis showed that the area under the curve (AUC) of VIS, NT-proBNP, and blood lactate at 6 h after admission for predicting poor prognosis in adult sepsis patients was 0.673, 0.790, and 0.702 respectively. When the cut-off values were 3.86, l.69,and 3.35, the sensitivity was 40.5 %, 71.8 %, and 59.3 %, the specificity was88.2 %, 65.8 %, and 72.9 %, and the Youden index was 0.288, 0.501, and 0.324, respectively. 3. Kaplan-Meier analysis revealed statistically significant differences in survival prognosis between patients with VIS >1.69 and VIS ≤1.69 (Log-rank χ² = 18.404, P < 0.001), NT-proBNP >3.86 and NT-proBNP ≤3.86 (Log-rank χ² = 38.282, P < 0.001), as well as blood lactate >3.35 and blood lactic acid ≤3.35 after a duration of 6 h from admission (Log-rank χ² = 11.776, P < 0.001).

Conclusion

VIS, NT-proBNP, and blood lactic acid levels 6 h post-admission independently contributed to the poor prognosis observed in adult sepsis patients; thus serving as valuable prognostic indicators for this population.