Clinical value of B-type natriuretic peptide in predicting the occurrence and development of acute kidney injury in critically ill patients

doi:10.3877/cma.j.issn.1674-6880.2022.04.003

Abstract

Abstract:

Objective

To explore the clinical value of B-type natriuretie peptide (BNP) in predicting the occurrence and development of acute kidney injury (AKI) in critically ill patients.

Methods

A retrospective analysis was performed on 591 patients who were admitted to the ICU of Zhejiang Provincial People's Hospital from October 2019 to September 2021. The patients were grouped into the AKI group (345 cases) and AKI-free group (246 cases) according to the presence or absence of AKI during the ICU stay. According to the severity of AKI, they were further grouped into the AKI-free group (246 cases), AKI-class 1 group (71 cases), AKI-class 2 group (63 cases) and AKI-class 3 group (211 cases). The clinical data of all patients were compared, and multivariate Logistic regression analysis was used to screen independent risk factors for AKI in severe patients.

Results

The differences of sepsis (χ² = 6.326, P = 0.012), acute physiology and chronic health evaluation Ⅱ score (t = 2.393, P = 0.017), sequential organ failure assessment score (t = 3.146, P = 0.002), hospitalization time (Z = 3.413, P = 0.001), 28-day mortality (χ² = 29.138, P < 0.001), in-hospital mortality (χ² = 34.265, P < 0.001), albumin (t = 2.213, P = 0.027), lactate (t = 2.049, P = 0.037), BNP on the first day of ICU admission (BNP-1) (Z = 4.285, P < 0.001), BNP on the third day of ICU admission (BNP-3) (Z = 6.717, P < 0.001), BNP rise rate (Z = 4.319, P < 0.001), urea nitrogen (Z = 3.231, P < 0.001) and serum creatinine (Z = 4.560, P < 0.001) were all statistically significant between the AKI group and AKI-free group. There were also significant differences in the BNP-1, BNP-3 and BNP rise rate among the AKI-free group, AKI-class 1 group, AKI-class 2 group and AKI-class 3 group (H = 11.468, 29.302, 18.366; all P < 0.05), and the BNP-3 level of AKI-class 3 group was higher than that of AKI-free group, AKI-class 1 group and AKI-class 2 group (all P < 0.05). In addition, multivariate Logistic regression analysis showed that the BNP-3 level [odds ratio (OR) = 1.000, 95% confidence interval (CI) (1.000, 1.001), P = 0.026] and serum creatinine level [OR = 1.002, 95%CI (1.000, 1.003), P = 0.019] were independent risk factors for AKI in severe patients.

Conclusions

The BNP level of critically ill patients, especially on the third day of ICU admission, is significantly correlated with the occurrence and severity of AKI. BNP has certain predictive value in the occurrence and development of AKI.

Key words: Critically ill patients, Acute kidney injury, B-type natriuretic peptide, Prediction, Clinical value

Minhua Chen, Zheng Zhu, Jun Jin, Renhua Sun, Jianliang Chen. Clinical value of B-type natriuretic peptide in predicting the occurrence and development of acute kidney injury in critically ill patients[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(04): 279-284.

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References 28

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组别	例数	年龄（岁，±s）	性别比（例，男/女）	原发疾病性质（例，内科/外科）	脓毒症[例（%）]	血管活性药物使用率[例（%）]	APACHEⅡ评分（分，±s）
无AKI组	246	62 ± 19	174/72	166/80	47（19.11）	88（35.77）	19 ± 8
AKI组	345	63 ± 18	243/102	230/115	97（28.12）	149（43.19）	21 ± 7
t/χ²/Z值		0.911	0.006	0.043	6.326	3.288	2.393
P值		0.362	0.938	0.836	0.012	0.070	0.017
组别	例数	SOFA评分（分，±s）	机械通气时间（d）	住ICU时间（d）	住院时间（d）	28 d病死率[例（%）]	住院病死率[例（%）]
无AKI组	246	7±3	9（4，20）	13（7，27）	25（13，54）	50（20.33）	71（28.86）
AKI组	345	8±4	9（4，16）	12（7，20）	19（10，34）	143（41.45）	183（53.04）
t/χ²/Z值		3.146	0.311	1.141	3.413	29.138	34.265
P值		0.002	0.756	0.157	0.001	<0.001	<0.001

组别	例数	年龄（岁，±s）	性别比（例，男/女）	原发疾病性质（例，内科/外科）	脓毒症[例（%）]	血管活性药物使用率[例（%）]	APACHEⅡ评分（分，±s）
无AKI组	246	62 ± 19	174/72	166/80	47（19.11）	88（35.77）	19 ± 8
AKI组	345	63 ± 18	243/102	230/115	97（28.12）	149（43.19）	21 ± 7
t/χ²/Z值		0.911	0.006	0.043	6.326	3.288	2.393
P值		0.362	0.938	0.836	0.012	0.070	0.017
组别	例数	SOFA评分（分，±s）	机械通气时间（d）	住ICU时间（d）	住院时间（d）	28 d病死率[例（%）]	住院病死率[例（%）]
无AKI组	246	7±3	9（4，20）	13（7，27）	25（13，54）	50（20.33）	71（28.86）
AKI组	345	8±4	9（4，16）	12（7，20）	19（10，34）	143（41.45）	183（53.04）
t/χ²/Z值		3.146	0.311	1.141	3.413	29.138	34.265
P值		0.002	0.756	0.157	0.001	<0.001	<0.001

组别	例数	白细胞计数（× 10⁹/L，±s）	白蛋白（g/L，±s）	总胆红素（μmol/L）	血乳酸（mmol/L，±s）	BNP-1（ng/L）	BNP-3（ng/L）	BNP上升率（%）	尿素氮（mmol/L）	血清肌酐（μmol/L）
无AKI组	246	13.1 ± 7.2	31 ± 7	15.9（10.3，25.2）	2.88 ± 2.87	132（44，377）	111（35，328）	-15（-78，25）	7.26（5.16，11.15）	88（69，122）
AKI组	345	13.4 ± 7.1	30 ± 7	16.5（11.1，25.5）	3.39 ± 3.02	243（74，956）	333（95，1 002）	9（-34，50）	8.45（5.92，15.33）	112（77，186）
t/Z值		0.444	2.213	1.473	2.049	4.285	6.717	4.319	3.231	4.560
P值		0.658	0.027	0.141	0.037	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	白细胞计数（× 10⁹/L，±s）	白蛋白（g/L，±s）	总胆红素（μmol/L）	血乳酸（mmol/L，±s）	BNP-1（ng/L）	BNP-3（ng/L）	BNP上升率（%）	尿素氮（mmol/L）	血清肌酐（μmol/L）
无AKI组	246	13.1 ± 7.2	31 ± 7	15.9（10.3，25.2）	2.88 ± 2.87	132（44，377）	111（35，328）	-15（-78，25）	7.26（5.16，11.15）	88（69，122）
AKI组	345	13.4 ± 7.1	30 ± 7	16.5（11.1，25.5）	3.39 ± 3.02	243（74，956）	333（95，1 002）	9（-34，50）	8.45（5.92，15.33）	112（77，186）
t/Z值		0.444	2.213	1.473	2.049	4.285	6.717	4.319	3.231	4.560
P值		0.658	0.027	0.141	0.037	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	BNP-1（ng/L）	BNP-3（ng/L）	BNP上升率（%）
无AKI组	246	132（44，377）	111（35，328）	-14.78（-78.15，25.00）
AKI-1级组	71	167（75，1 300）^a	226（70，1 380）^a	0（-47.74，36.14）
AKI-2级组	63	71（21，285）^ab	96（39，535）^b	13.21（-8.15，63.19）^ab
AKI-3级组	211	477（130，1 474）^ac	559（239，1 607）^abc	13.22（-0.27，63.78）^a
H值		11.468	29.302	18.366
P值		0.009	<0.001	<0.001

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