Soriano Andres O, Jy Wenche, Chirinos Julio A, Valdivia Martin A, Velasquez Hermes S, Jimenez Joaquin J, Horstman Lawrence L, Kett Daniel H, Schein Roland M H, Ahn Yeon S
Wallace H. Coulter Platelet Laboratory, Division of Hematology/Oncology, University of Miami School of Medicine, Miami, FL 33136, USA.
Crit Care Med. 2005 Nov;33(11):2540-6. doi: 10.1097/01.ccm.0000186414.86162.03.
Mortality in sepsis is believed to be associated with exaggerated inflammatory responses, but recent evidence suggests that poor outcome is associated with reduced inflammation. To test this hypothesis, we measured several inflammatory markers to determine whether any of them or any combinations are associated with mortality or organ dysfunction.
Clinical study.
School of medicine.
Thirty-five patients with severe sepsis.
Markers of endothelial, platelet, and leukocyte activation were measured on days 1, 2, and 3 after enrollment. The markers were a) endothelial microparticles (EMPs) and their conjugates with monocytes (EMP/MONO); b) platelet microparticles (PMPs) and platelet activation marker CD62P; c) platelet-leukocyte conjugates (PLT/LEU) and leukocyte activation marker CD11b; and d) intracellular nitric oxide in leukocytes.
The 28-day mortality rate was 51% (18 of 35). Significant differences between survivors and nonsurvivors on day 1 were found in PLT/LEU (p = .001), CD11b (p = 0.02), and EMP/MONO (p = .02) groups. Using logistic regression to assess if these markers predict mortality on day 1, we found that PLT/LEU had the best predictive value among the markers used (area under receiver operating characteristics curve = 0.82). All markers of cell activation and inflammation were significantly higher among survivors on days 2 and 3, except nitric oxide, which was lower. This marker showed significant negative correlation with the Sequential Organ Failure Assessment score throughout the study.
Our data support the hypothesis that early increased, not decreased, inflammatory response as measured by our markers is associated with improved survival rate. A high negative correlation was found between some of these markers and Sequential Organ Failure Assessment score.
脓毒症的死亡率被认为与过度的炎症反应有关，但最近的证据表明，不良预后与炎症反应减弱有关。为了验证这一假设，我们检测了几种炎症标志物，以确定它们中的任何一种或任何组合是否与死亡率或器官功能障碍有关。
临床研究。
医学院。
35例严重脓毒症患者。
在入组后的第1、2和3天测量内皮细胞、血小板和白细胞活化标志物。这些标志物包括：a）内皮微粒（EMPs）及其与单核细胞的结合物（EMP/MONO）；b）血小板微粒（PMPs）和血小板活化标志物CD62P；c）血小板-白细胞结合物（PLT/LEU）和白细胞活化标志物CD11b；d）白细胞内的一氧化氮。
28天死亡率为51%（35例中的18例）。在第1天，存活者和非存活者在PLT/LEU组（p = 0.001）、CD11b组（p = 0.02）和EMP/MONO组（p = 0.02）存在显著差异。使用逻辑回归评估这些标志物是否能预测第1天的死亡率，我们发现PLT/LEU在所使用的标志物中具有最佳预测价值（受试者工作特征曲线下面积 = 0.82）。在第2天和第3天，除一氧化氮较低外，存活者中所有细胞活化和炎症标志物均显著更高。在整个研究过程中，该标志物与序贯器官衰竭评估评分呈显著负相关。
我们的数据支持这样的假设，即通过我们检测的标志物测量，早期炎症反应增加而非减少与生存率提高有关。这些标志物中的一些与序贯器官衰竭评估评分之间存在高度负相关。
