A novel score based on age and cardiac biomarkers predicts outcomes in severe sepsis and septic shock

Background

Myocardial dysfunction is common among critically ill septic patients. Elevated levels of cardiac biomarkers are predictors of mortality in acute coronary syndrome and in unselected critically ill patients. Our aim was to evaluate the role of the cardiac markers NT-proBNP, Troponin T (TnT) and myoglobin as predictors of inhospital and 6-month all-cause mortality in patients admitted to a general adult ICU with severe sepsis/septic shock.

Methods

Serial plasma samples were taken for five sequential days on all patients admitted with severe sepsis/septic shock. Samples were analysed for NT-proBNP, TnT and myoglobin.

Results

Samples were analysed on 49 patients. Elevated myoglobin was the only predictor of ICU mortality. Age, myoglobin and NT-proBNP levels predicted hospital mortality. Predictors of 6-month mortality were age, peak TnT, peak myoglobin and peak NT-proBNP levels. The APACHE II score did not predict mortality. A score was established dependent on TnT (<0.1 = 1, ≥0.1 = 2), age (<65 years = 1, ≥65 years = 2), BNP (<10,000 = 1, >10,000 = 2), and myoglobin (<750 = 1, >750 = 2). Patients were placed into tertiles (score = 4&5, 6, 7&8) to produce survival curves (Figure 1, P < 0.01).

Figure 1

(abstract P450)

Conclusion

In critically ill patients with severe sepsis/septic shock a score based on age and increased plasma levels of cardiac biomarkers can help risk-stratify patients and predict short-term (<6 months) outcome.