Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Austria.
Clin Chim Acta. 2012 Mar 22;413(5-6):587-93. doi: 10.1016/j.cca.2011.11.028. Epub 2011 Dec 6.
Soluble ST2 (sST2) has emerged as a prognostic biomarker in patients with heart disease. We tested the hypothesis that sST2 is an independent predictor of mortality in patients admitted to an intensive care unit (ICU).
We performed measurements of sST2 plasma concentrations in 530 consecutive patients admitted to a medical ICU of a tertiary care hospital during a study period of one year. The patients recruited during the first six months were used for the derivation cohort (n=274) and the patients recruited during the second six months were used for the validation cohort (n=256). The endpoint was defined as 90-day all-cause mortality.
In the derivation cohort, sST2 was higher among decedents (n=56; median, 146 U/mL) than survivors (n=218; median 42 U/mL, p<0.001). In multivariate Cox proportional-hazard regression analysis (offering age, sex, BMI, APACHE II score, SAPS II, CRP, IL-6, PCT, creatinine, total cholesterol, albumin, hs-cTnT, BNP and sST2 as independent variables), sST2 was a significant predictor of mortality (risk ratio 1.48, 95% CI 1.15-1.90; p=0.002 per 1 SD increase in log transformed values). In this statistical model, only sST2 and SAPS II contributed independently to mortality prediction. We further observed an additive effect of an sST2 plasma concentration of >84 U/mL and an increased SAPS II for mortality prediction. The findings from the derivation cohort were confirmed in the independent validation cohort. In those patients with a length of stay of >48 h at the ICU (n=225), sST2 obtained two days after baseline measurement had a better capability than baseline sST2 to predict mortality.
In an unselected cohort of patients admitted to the ICU, sST2 was an independent predictor of 90-day all-cause mortality and added prognostic information to the SAPS II.
可溶性 ST2（sST2）已成为心脏病患者的预后生物标志物。我们检验了这样一个假设，即 sST2 是重症监护病房（ICU）收治患者死亡率的独立预测因子。
我们对一家三级医院 ICU 收治的 530 例连续患者进行了 sST2 血浆浓度的测量。前 6 个月入组的患者用于推导队列（n=274），后 6 个月入组的患者用于验证队列（n=256）。终点定义为 90 天全因死亡率。
在推导队列中，死亡患者（n=56；中位数，146 U/mL）的 sST2 高于存活患者（n=218；中位数 42 U/mL，p<0.001）。在多变量 Cox 比例风险回归分析（将年龄、性别、BMI、APACHE II 评分、SAPS II、CRP、IL-6、PCT、肌酐、总胆固醇、白蛋白、hs-cTnT、BNP 和 sST2 作为独立变量）中，sST2 是死亡率的显著预测因子（风险比 1.48，95%CI 1.15-1.90；每增加 1 个标准差的 log 转换值，p=0.002）。在这个统计模型中，只有 sST2 和 SAPS II 独立地对死亡率预测有贡献。我们还观察到 sST2 血浆浓度>84 U/mL 和 SAPS II 增加对死亡率预测的附加效应。推导队列的结果在独立验证队列中得到了证实。在 ICU 住院时间>48 h 的患者（n=225）中，基线测量后两天的 sST2 比基线 sST2 更能预测死亡率。
在 ICU 收治的未选择患者队列中，sST2 是 90 天全因死亡率的独立预测因子，并为 SAPS II 增加了预后信息。
