The Levels of Lactate, Troponin, and N-Terminal Pro-B-Type Natriuretic Peptide Are Predictors of Mortality in Patients with Sepsis and Septic Shock: A Retrospective Cohort Study

Abstract

Background Serum lactate, troponin, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been proposed to be useful prognostic indicators in patients with sepsis and septic shock. This study aimed to evaluate the predictive ability of these biomarkers and assess how their prognostic utility may be improved by using them in combination. Material/Methods A retrospective review of the medical records of 1242 patients with sepsis and septic shock who were admitted to the Richmond University Medical Center between June 1, 2018, and June 1, 2019, was carried out; 427 patients met the study criteria and were included in the study. The primary outcome measures included 30-day mortality, APACHE II scores, length of hospital stay, and admission to the Medical Intensive Care Unit (MICU). Results High levels of lactate (>4 mmol/L), troponin (>0.45 ng/mL), and NT-proBNP (>8000 pg/mL) were independent predictors of 30-day mortality, with an adjusted odds ratio of mortality being 3.19 times, 2.13 times, and 2.5 times higher, respectively, compared with corresponding reference groups, at 95% confidence intervals. Elevated levels of lactate, troponin, and NT-proBNP were associated with 9.12 points, 7.70 points, and 8.88 points in higher APACHE II scores, respectively. Only elevated troponin levels were predictive of a longer length of hospital stay. In contrast, elevated lactate and troponin were associated with an increased chance of admission to the MICU. Conclusions Elevated levels of serum lactate, troponin, and NT-proBNP are independent predictors of mortality and higher APACHE II scores in patients with sepsis and septic shock.

Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis

“…Detailed characteristics of the included studies can be found in Table 1. Among the included studies, before-treatment blood lactate measured values had been documented in 78 studies [6,[9][10][11][12][13][15][16][17][18][19]. Also, most of them provided data on the association between nonsepsis, sepsis, severe sepsis and septic shock and different blood lactate values.…”

“…However, there exists inconsistency in the reference criteria for predicting the prognosis of sepsis in cases of elevated lactate levels. While certain studies emphasized an initial lactate level greater than 2.0 mmol/L as indicative of elevated lactate levels [15,16], others suggested that elevated lactate levels are defined by an initial lactate level exceeding 4.0 mmol/L [17][18][19]. Furthermore, there is no relevant quantitative metaanalysis focusing on different blood lactate level to predict different outcomes in sepsis, such as severe sepsis and septic shock.…”

Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events

“…Other mechanisms of myocardial ischemia resulting from coronary artery pathology include coronary artery spasm [ 57 ] or dissection [ 58 ], as well as coronary embolism [ 59 ]. Ischemic myocardial damage may also result from disproportions between oxygen supply and demand due to conditions such as bradyarrhythmia [ 60 ], tachyarrhythmia [ 61 ], poorly controlled hypertension resulting in left ventricular hypertrophy [ 62 ], respiratory failure [ 63 ], hypotension [ 64 ], shock (different types, both cardiogenic and non-cardiogenic) [ 65 , 66 , 67 ], or severe anemia [ 68 ]. Moreover, important diseases in which elevated cardiac troponin levels are observed include heart failure [ 69 , 70 , 71 ], myocarditis [ 72 , 73 ], and chronic renal failure [ 74 , 75 ].…”

Age-adjusted NT-proBNP could help in the early identification and follow-up of children at risk for severe multisystem inflammatory syndrome associated with COVID-19 (MIS-C)

“…Notably, its secretion is also influenced by the inflammatory response[ 20 , 21 ]. NT-proBNP is increasingly used as a biomarker in pediatric conditions that combine myocardial stress and inflammatory diseases, such as sepsis or Kawasaki disease[ 22 - 24 ]. Therefore, it is not surprising that NT-proBNP levels are markedly raised in almost all patients with MIS-C, where the proposed mechanism for the cardiovascular dysfunction is myocardial inflammation related to systemic inflammation with a cytokine storm[ 4 , 8 , 11 , 25 , 26 ].…”