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Comparative Assessment of Cardiac Biomarkers and APACHE II Score for Prognostication in Septicemic Patients at a
Shefali Meena1, C L Nawal2, Hazari L Saini3
1Junior Resident, Department of General Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Introduction:
Cardiac dysfunction is one of the major causes of mortality in patients with sepsis. The acute physiology and chronic health evaluation II (APACHE II), quick sequential organ failure assessment (qSOFA), and other prognostic scores for sepsis have established data regarding their accuracy in predicting mortality. We have assessed the prognostic role of cardiac biomarkers [creatine phosphokinase-myocardial band (CPK-MB), troponin I (Trop I), and probrain natriuretic peptide (proBNP)] in patients with sepsis and compared it with the APACHE II score.
Materials And Methods:
A total of 126 patients (63 in each group) participated in this case-control study in a large tertiary care teaching hospital. Patients with sepsis who required hospitalization were enrolled in the case group and compared with another group of nonsepticemic patients. They were taken for detailed evaluation and investigation on day 1 and day 3. Our study included proBNP, CPK-MB, Trop I, and APACHE II score.
Results:
Both the case and control groups comprised 63 patients each. It was observed that the cardiac biomarkers (proBNP, Trop I, CPK-MB) were markedly higher among cases than in controls. Similarly, these markers were also found markedly higher in fatal cases than survivors in the case group. Out of all three biomarkers, proBNP was correlated well with mortality as much as the APACHE II score. It was also observed that increasing trends in the levels of biomarkers depict prognosis more effectively than a single value.
Conclusion:
We conclude that cardiac biomarkers can be routinely used as dynamic markers for the prediction of mortality and prognosis in patients with sepsis. ProBNP may be useful in predicting mortality in patients with sepsis.
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