Rivers Emanuel P, Kruse James A, Jacobsen Gordon, Shah Kant, Loomba Manisha, Otero Ronny, Childs Ed W
Department of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, MI, USA.
Crit Care Med. 2007 Sep;35(9):2016-24. doi: 10.1097/01.ccm.0000281637.08984.6e.
Despite abundant experimental studies of biomarker patterns in early severe sepsis and septic shock, human data are few. Further, the impact of the severity of global tissue hypoxia resulting from resuscitative strategies on these early biomarker patterns remains unknown.
The temporal patterns of interleukin-1 receptor antagonist, intercellular adhesion molecule-1, tumor necrosis factor-alpha, caspase-3, and interleukin-8 were serially examined over the first 72 hrs of hospitalization after early hemodynamic optimization strategies of early goal-directed vs. standard therapy for severe sepsis and septic shock patients. The relationship of these biomarker patterns to each hemodynamic optimization strategy, severity of global tissue hypoxia (reflected by lactate and central venous oxygen saturation), organ dysfunction, and mortality were examined.
Abnormal biomarker levels were present upon hospital presentation and modulated to distinct patterns within 3 hrs based on the hemodynamic optimization strategy. The temporal expression of these patterns over 72 hrs was significantly associated with the severity of global tissue hypoxia, organ dysfunction, and mortality.
In early severe sepsis and septic shock, within the first 3 hrs of hospital presentation, distinct biomarker patterns emerge in response to hemodynamic optimization strategies. A significant association exists between temporal biomarker patterns in the first 72 hrs, severity of global tissue hypoxia, organ dysfunction, and mortality. These findings identify global tissue hypoxia as an important contributor to the early inflammatory response and support the role of hemodynamic optimization in supplementing other established therapies during this diagnostic and therapeutic "window of opportunity."
尽管对早期严重脓毒症和脓毒性休克的生物标志物模式进行了大量实验研究，但人体数据却很少。此外，复苏策略导致的全身组织缺氧严重程度对这些早期生物标志物模式的影响仍不清楚。
在对严重脓毒症和脓毒性休克患者采用早期目标导向治疗与标准治疗的早期血流动力学优化策略后，在住院的前72小时内连续检测白细胞介素-1受体拮抗剂、细胞间黏附分子-1、肿瘤坏死因子-α、半胱天冬酶-3和白细胞介素-8的时间模式。研究了这些生物标志物模式与每种血流动力学优化策略、全身组织缺氧严重程度（由乳酸和中心静脉血氧饱和度反映）、器官功能障碍和死亡率之间的关系。
入院时生物标志物水平异常，并根据血流动力学优化策略在3小时内调整为不同模式。这些模式在72小时内的时间表达与全身组织缺氧严重程度、器官功能障碍和死亡率显著相关。
在早期严重脓毒症和脓毒性休克中，入院后的前3小时内，会出现针对血流动力学优化策略的不同生物标志物模式。在最初72小时内的生物标志物时间模式、全身组织缺氧严重程度、器官功能障碍和死亡率之间存在显著关联。这些发现表明全身组织缺氧是早期炎症反应的重要促成因素，并支持血流动力学优化在这一诊断和治疗“机会窗”期间补充其他既定疗法的作用。
