Abstract
This study investigates the value of combining N-terminal pro-B-type natriuretic peptide (NT-proBNP), neutrophil-to-lymphocyte ratio (NLR), angiopoietin-1 (Ang-1) with the acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores for the assessment of 28-day mortality in septic shock. This retrospective study enrolled 121 hospitalized patients with septic shock admitted from February 2022 to February 2023 and followed them up. They were grouped based on whether they died within 28 days. 44 patients who died were included in the death group, while the other 77 patients were included in the survival group. Clinical data differences between the groups were compared, and the predictive value of NT-proBNP, NLR, Ang-1, APACHE II, and SOFA scores for mortality within 28 days was explored. The patients in the death group and the survival group showed no differences in gender, past medical history (hypertension, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease), recent surgical history, age, shock index, and oxygenation index (P > .05). However, the levels of blood creatinine and lactate were higher in the death group compared to the survival group (P < .05). The levels of NT-proBNP, NLR, Ang-1, as well as APACHE II and SOFA scores were higher in the deceased group compared to the survival group (P < .05). Multiple-factor logistic regression analysis indicated that creatinine, NT-proBNP, NLR, Ang-1, APACHE II score, and SOFA score all significantly influenced the survival status of patients (P < .05). Based on the aforementioned multifactorial analysis results, a logistic regression model was established. Using this model as the independent variable, ROC curve analysis was conducted with patient mortality within 28 days as the dependent variable. The area under the curve (AUC) value was found to be 0.844, with a 95% CI of 0.772 to 0.916. Sensitivity was 0.841, and specificity was 0.701. The optimal cutoff value was determined to be 123.56. The model exhibited good fit (Hosmer-Lemeshow χ2 = 3.458, P = .788). The combined analysis of NT-proBNP, NLR, Ang-1 levels, along with APACHE II and SOFA scores, can effectively predict the 28-day mortality risk in patients with septic shock. These indicators have important clinical value in early identification of high-risk patients and guiding treatment decisions.