Group of Primary Immunodeficiencies, University of Antioquia, Medellín, Colombia.
Acad Emerg Med. 2011 Aug;18(8):807-15. doi: 10.1111/j.1553-2712.2011.01113.x. Epub 2011 Jul 18.
The objectives were to evaluate the diagnostic accuracy for sepsis in an emergency department (ED) population of the cluster of differentiation-64 (CD64) glycoprotein expression on the surface of neutrophils (nCD64), serum levels of soluble triggering receptor expressed on myeloid cells-1 (s-TREM-1), and high-mobility group box-1 protein (HMGB-1).
Patients with any of the following as admission diagnosis were enrolled: 1) suspected infection, 2) fever, 3) delirium, or 4) acute hypotension of unexplained origin within 24 hours of ED presentation. Levels of nCD64, HMGB-1, and s-TREM-1 were measured within the first 24 hours of the first ED evaluation. Baseline clinical data, Sepsis-related Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, daily clinical and microbiologic information, and 28-day mortality rate were collected. Because there is not a definitive criterion standard for sepsis, the authors used expert consensus based on clinical, microbiologic, laboratory, and radiologic data collected for each patient during the first 7 days of hospitalization. This expert consensus defined the primary outcome of sepsis, and the primary data analysis was based in the comparison of sepsis versus nonsepsis patients. The cut points to define sensitivity and specificity values, as well as positive and negative likelihood ratios (LRs) for the markers related to sepsis diagnosis, were determined using receiver operative characteristics (ROC) curves. The patients in this study were a prespecified nested subsample population of a larger study.
Of 631 patients included in the study, 66% (95% confidence interval [CI] = 62% to 67%, n = 416) had sepsis according with the expert consensus diagnosis. Among these sepsis patients, SOFA score defined 67% (95% CI = 62% to 71%, n = 277) in severe sepsis and 1% (95% CI = 0.3% to 3%, n = 6) in septic shock. The sensitivities for sepsis diagnosis were CD64, 65.8% (95% CI = 61.1% to 70.3%); HMGB-1, 57.5% (95% CI = 52.7% to 62.3%); and s-TREM-1, 60% (95% CI = 55.2% to 64.7%). The specificities were CD64, 64.6% (95% CI = 57.8% to 70.8%), HMGB-1, 57.8% (95% CI = 51.1% to 64.3%), and s-TREM-1, 59.2% (95% CI = 52.5% to 65.6%). The positive LR (LR+) for CD64 was 1.85 (95% CI = 1.52 to 2.26) and the negative LR (LR-) was 0.52 (95% CI = 0.44 to 0.62]; for HMGB-1 the LR+ was 1.36 (95% CI = 1.14 to 1.63) and LR- was 0.73 (95% CI = 0.62 to 0.86); and for s-TREM-1 the LR+ was 1.47 (95% CI = 1.22 to 1.76) and the LR- was 0.67 (95% CI = 0.57 to 0.79).
In this cohort of patients suspected of having any infection in the ED, the accuracy of nCD64, s-TREM-1, and HMGB-1 was not significantly sensitive or specific for diagnosis of sepsis.
评估在急诊科（ED）人群中，中性粒细胞表面分化群 64（CD64）糖蛋白表达（nCD64）、可溶性髓系细胞触发受体 1（s-TREM-1）和高迁移率族蛋白 B1（HMGB-1）的血清水平对脓毒症的诊断准确性。
纳入以下任何一种入院诊断的患者：1）疑似感染，2）发热，3）谵妄，或 4）ED 就诊后 24 小时内不明原因的急性低血压。在首次 ED 评估的 24 小时内测量 nCD64、HMGB-1 和 s-TREM-1 水平。收集基线临床数据、脓毒症相关器官衰竭评估（SOFA）评分、急性生理学和慢性健康评估（APACHE II）评分、每日临床和微生物学信息以及 28 天死亡率。由于没有明确的脓毒症标准，作者根据每位患者住院前 7 天收集的临床、微生物学、实验室和影像学数据，采用基于专家共识的方法进行诊断。该专家共识定义了脓毒症的主要结局，主要数据分析基于脓毒症与非脓毒症患者的比较。使用接收者工作特征（ROC）曲线确定与脓毒症诊断相关标志物的灵敏度和特异性值以及阳性和阴性似然比（LR）的截断值。本研究中的患者是一项较大研究的预先指定嵌套亚组人群。
在纳入的 631 例患者中，根据专家共识诊断，66%（95%置信区间[CI] = 62%至 67%，n = 416）的患者患有脓毒症。在这些脓毒症患者中，SOFA 评分定义了 67%（95%CI = 62%至 71%，n = 277）为严重脓毒症和 1%（95%CI = 0.3%至 3%，n = 6）为脓毒性休克。脓毒症诊断的敏感性为 CD64，65.8%（95%CI = 61.1%至 70.3%）；HMGB-1，57.5%（95%CI = 52.7%至 62.3%）；s-TREM-1，60%（95%CI = 55.2%至 64.7%）。特异性为 CD64，64.6%（95%CI = 57.8%至 70.8%）；HMGB-1，57.8%（95%CI = 51.1%至 64.3%）；s-TREM-1，59.2%（95%CI = 52.5%至 65.6%）。CD64 的阳性似然比（LR+）为 1.85（95%CI = 1.52 至 2.26），阴性似然比（LR-）为 0.52（95%CI = 0.44 至 0.62）；HMGB-1 的 LR+为 1.36（95%CI = 1.14 至 1.63），LR-为 0.73（95%CI = 0.62 至 0.86）；s-TREM-1 的 LR+为 1.47（95%CI = 1.22 至 1.76），LR-为 0.67（95%CI = 0.57 至 0.79）。
在这个疑似任何感染的 ED 患者队列中，nCD64、s-TREM-1 和 HMGB-1 的准确性对脓毒症的诊断既不敏感也不特异。
