Heart-type fatty acid–binding protein as a prognostic factor in patients with severe sepsis and septic shock☆
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Fig. 1
Log odds of mortality in patients with severe sepsis and septic shock according to the concentration of H-FABP. The dashed lines indicate 95% confidence interval.
Fig. 2
Probability of 28-day survival in patients with severe sepsis and septic shock. P<.001 by the log-rank test.
Fig. 3
Receiver operating curves for 28-day mortality. The AUCs were 0.771 (95% confidence interval, 0.674-0.868) for APACHE II, 0.779 (95% confidence interval, 0.681-0.877) for albumin, 0.739 (95% confidence interval, 0.640-0.839) for H-FABP, and 0.699 (95% confidence interval, 0.589-0.808) for NT-proBNP. P=.956 between APACHE II and albumin; P=.843 between APACHE II and H-FABP; P=.785 between albumin and H-FABP; P=.325 between APACHE II and NT-proBNP.
Abstracts
Objective
This study was performed to evaluate whether heart-type fatty acid–binding protein (H-FABP) could predict 28-day mortality in patients with severe sepsis and septic shock.
Methods
We performed a prospective observational study and included consecutive patients with severe sepsis and septic shock. Patients' demographic data, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the blood test results including H-FABP concentrations were compared between the 28-day survivors and nonsurvivors. The association between the concentration of H-FABP and survival was analyzed with multivariate logistic regression and Cox proportional hazards regression analyses. The prognostic performance of H-FABP was compared with those of the APACHE II score and albumin using the area under the receiver operating characteristic curve.
Results
Of the 99 patients, 38 (38%) died. The mortality rate increased with increasing H-FABP concentration. In multivariate logistic regression analyses, H-FABP greater than 40 ng/mL was an independent predictor of mortality compared with H-FABP less than 7 ng/mL (odds ratios, 9.23; 95% confidence interval, 1.29-65.86). By Cox proportional hazards analysis, H-FABP greater than 40 ng/mL was associated with a 5.57-fold increased risk for death during the 28-day follow-up period (hazard ratio, 5.57; 95% confidence interval, 1.20-25.80). The area under the receiver operating characteristic curve of H-FABP was 0.739 (95% confidence interval, 0.640-0.839), which was comparable with those of the APACHE II score and albumin.
Conclusion
The H-FABP was an independent prognostic factor and could be a useful biomarker for 28-day mortality in patients with severe sepsis and septic shock.
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☆Sources of support: This study was supported by Grant No. 02-2011-039 SNUBH (Seoul National University Bundang Hospital) Research Fund. The CardioDetect kit was supported by Rennesens GmbH (Berlin, Germany).
