Prognostic value of NT-proBNP levels in the acute phase of sepsis on lower long-term physical function and muscle strength in sepsis survivors

Abstract

Background: Sepsis survivors often develop chronic critical illness (CCI) and demonstrate the persistent inflammation, immunosuppression, and catabolism syndrome predisposing them to long-term functional limitations and higher mortality. There is a need to identify biomarkers that can predict long-term worsening of physical function to be able to act early and prevent mobility loss. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-accepted biomarker of cardiac overload, but it has also been shown to be associated with long-term physical function decline. We explored whether NT-proBNP blood levels in the acute phase of sepsis are associated with physical function and muscle strength impairment at 6 and 12 months after sepsis onset. Methods: This is a retrospective analysis conducted in 196 sepsis patients (aged 18-86 years old) as part of the University of Florida (UF) Sepsis and Critical Illness Research Center (SCIRC) who consented to participate in the 12-month follow-up study. NT-proBNP was measured at 24 h after sepsis onset. Patients were followed to determine physical function by short physical performance battery (SPPB) test score (scale 0 to12-higher score corresponds with better physical function) and upper limb muscle strength by hand grip strength test (kilograms) at 6 and 12 months. We used a multivariate linear regression model to test an association between NT-proBNP levels, SPPB, and hand grip strength scores. Missing followup data or absence due to death was accounted for by using inverse probability weighting based on concurrent health performance status scores. Statistical significance was set at p ≤ 0.05. Results: After adjusting for covariates (age, gender, race, Charlson comorbidity index, APACHE II score, and presence of CCI condition), higher levels of NT-proBNP at 24 h after sepsis onset were associated with lower SPPB scores at 12 months (p < 0.05) and lower hand grip strength at 6-month (p < 0.001) and 12-month follow-up (p < 0.05). Conclusions: NT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors.

Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – Results of an expert consensus and feasibility field test

“…63,64 Several studies have assessed both TUG 96–98 and handgrip strength dynamometry in ICU survivors. 98–103 Some of these investigations also reported promising data on measurement quality of both tests in ICU survivors. 96,100–103…”

“…[98][99][100][101][102][103] Some of these investigations also reported promising data on measurement quality of both tests in ICU survivors. 96,[100][101][102][103] For the extended assessment of the physical function, we recommend handgrip strength and two additional physical tests. Handgrip strength, EQ-5D-5L, the NRS, and single items regarding new and worsening health problems are already part of the screening, but a repetition in synopsis with the additional tests allows for a reassessment of the initial impairment.…”

N-terminal pro-brain natriuretic peptide levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments: some confounders to consider

“…N-terminal pro-brain natriuretic peptide levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments: some confounders to consider Patrick M. Honore * , Cristina David, Aude Mugisha, Rachid Attou, Sebastien Redant, Andrea Gallerani and David De Bels Custodero et al conclude that N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors [1]. A letter from Jiarong et al has challenged this assertion, pointing to the exponential increase in the plasma level of NT-proBNP with a declining glomerular filtration rate.…”

“…Nearly half of critically ill patients, especially with septic shock, have or develop acute kidney injury (AKI) and 20-25% need renal replacement therapy (RRT) within the first week of their stay [3]. In the Custodero study, the two cohorts (chronic critical illness [CCI] and rapid recovery [RAP]) had a considerable difference in the incidence of septic shock (36.5% vs 16.4%), so it would stand to reason that the rate of AKI and continuous renal replacement therapy (CRRT) was much lower in the RAP cohort when compared to the CCI cohort [1]. CRRT is performed using membranes that have a cut-off value of 35-40 kDa and therefore some quantity of NT-proBNP will be eliminated [4].…”

NT-proBNP levels might predict outcomes in severe sepsis, but renal function cannot be ignored

“…We read with great interest the article by Carlo Custodero et al recently published in Critical Care [1]. The authors concluded that NT-proBNP levels during the acute phase of sepsis may be a useful indicator of higher risk of long-term impairments in physical function and muscle strength in sepsis survivors.…”