Background: Sepsis was one of health problem which cause a high risk of morbidity
and mortality. Releasing cytokines pro inflammatory with other factors caused Left
Ventricular Systolic Dysfunction (LVSD). In sepsis, there was a releasing of MR pro
ANP, PCT and TNF-a because of cytokines pro inflammatory stimulation.
Objectives: To prove MR pro ANP as LVSD biomarker, to determine AUC value,
sensitivity, specificity, cut off point value, and probability of MR pro ANP, PCT and
TNF-a as LVSD biomarker, to analyse the correlation between TNF-a and MR pro
ANP, the correlation between MR pro ANP and PCT, to find out the best diagnostic
predictor of LVSD.
Methods: Non experimental diagnostic test using cross sectional design. The simple
random sampling was taken consist of 71 sepsis patients. Variables examined were
MR pro ANP, PCT and TNF-a, and LVEF was examined using echocardiograph
(Simpson method). LVSD occurred if LVEF was = 45%. Data were analysed using
2x2 table and ROC curve and statistically analysed with SPSS 22 for window.
Results: AUC value of MR pro ANP was 0,84 (95% CI 0,73-0,95), p <0,001. Cut off
point of MR pro ANP was = 225,95 pmol/L with DOR 12,11 (95% CI 3,66-40,12).
AUC value of PCT was 0,81 (95% CI 0,71-0,91), p<0,001. Cut off point of PCT was
=7,875 ng/mL with DOR 5,55 (95% CI 1,88-16,42). AUC value of TNF-a was 0,73
(95% CI 0,60 - 0,86), p< 0,002. Cut off point of TNF-a was = 7,36 pg/mL with DOR
5,03 (95% CI 1,71-14,77). There was a weak positive correlation between TNF-a and
MR pro ANP (r=0,197, p=0,100). There was a positive correlation between PCT and
MR pro ANP (r=0,309, p=0,009). Multivariate analysis found MR pro ANP as the
best predictor for LVSD (AUC 0,78), PCT (AUC 0,70), and TNF-a (AUC 0,69). The
combination of MR pro ANP + PCT would increase diagnostic value with AUC 0,87.
Conclusions: MR pro ANP could be used as LVSD biomarker with AUC 0,84 (95%
CI 0,73-0,95), p <0,001, cut off point value = 225,95 pmol/L, DOR 12,11. AUC of
PCT was 0,81 (95% CI 0,71-0,91), p<0,001, cut off point value =7,875ng/mL, DOR
5,55. AUC of TNF-a was 0,71 (95% CI 0,60 - 0,86), p< 0,002, cut off point value =
7,36 pg / mL, DOR 5,03. There was a weak positive correlation between TNF-a and
MR pro ANP. PCT had a positive correlation with MR pro ANP. MR pro ANP was
the best LVSD diagnostic predictor. The combination of MR pro ANP + PCT was the
best and efficient diagnostic predictor of LVSD.
Keywords : Biomarker, Left Ventricular Systolic Dysfunction , MR pro ANP, PCT,