Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan.
Crit Care Med. 2013 Jun;41(6):1443-9. doi: 10.1097/CCM.0b013e31827ca960.
Sepsis is the leading cause of death among critically ill patients. There are, however, few appropriate biomarkers to predict mortality in patients with sepsis. We focused on maximal chemiluminescent intensity in response to lipopolysaccharide assessed by endotoxin activity assay and evaluated the diagnostic value of maximal chemiluminescent intensity on admission day as a predictor of mortality in patients with sepsis.
Prospective, observational study.
ICU.
One hundred and thirty-two patients with sepsis.
None.
Within 12 hours after admission, a whole-blood sample was collected, and variables assessed by endotoxin activity assay were measured in each patient. Severity of illness was assessed simultaneously by Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score. The primary outcome was 28-day mortality. One hundred and fifteen patients survived and 17 died. maximal chemiluminescent intensity values were significantly lower in the nonsurvivors than in the survivors (p <0.05). We investigated maximal chemiluminescent intensity, APACHE II score, and SOFA score as predictors of 28-day mortality. Receiver operating characteristic analysis showed that area under the curve for maximal chemiluminescent intensity was 0.902, which was superior to the area under the curves for APACHE II score (0.836) and SOFA score (0.807). At the optimal cutoff value for maximal chemiluminescent intensity, 21,000 RLU/s, the sensitivity for correct prediction of 28-day mortality was 82.4% and the specificity was 92.2%. Kaplan-Meier analysis showed that low maximal chemiluminescent intensity (<21,000 RLU/s) closely correlated with poor overall patient survival compared with high maximal chemiluminescent intensity (>21,000 RLU/s) (p <0.001 by log-rank test). After adjusting for APACHE II score by Cox regression analysis, maximal chemiluminescent intensity was identified as an independent predictor for the probability of 28-day mortality.
Maximal chemiluminescent intensity level measured on admission day appears to have high predictive value for mortality in patients with sepsis.
脓毒症是危重症患者死亡的主要原因。然而，目前用于预测脓毒症患者死亡率的合适生物标志物却很少。我们专注于通过内毒素活性测定评估脂多糖刺激后产生的最大化学发光强度，并评估入院当天最大化学发光强度作为预测脓毒症患者死亡率的指标的诊断价值。
前瞻性观察性研究。
重症监护病房。
132 例脓毒症患者。
无。
在入院后 12 小时内，采集全血样本，并测量每位患者的内毒素活性测定评估的变量。通过急性生理学和慢性健康评估（APACHE）Ⅱ评分和序贯器官衰竭评估（SOFA）评分同时评估疾病严重程度。主要结局为 28 天死亡率。115 例患者存活，17 例患者死亡。存活组与死亡组相比，最大化学发光强度值明显较低（p<0.05）。我们将最大化学发光强度、APACHE Ⅱ评分和 SOFA 评分作为 28 天死亡率的预测因子进行了研究。受试者工作特征曲线分析显示，最大化学发光强度的曲线下面积为 0.902，优于 APACHE Ⅱ评分（0.836）和 SOFA 评分（0.807）的曲线下面积。在最大化学发光强度的最佳截断值 21,000 RLU/s 时，对 28 天死亡率的正确预测的灵敏度为 82.4%，特异性为 92.2%。Kaplan-Meier 分析显示，与高最大化学发光强度（>21,000 RLU/s）相比，低最大化学发光强度（<21,000 RLU/s）与患者总体生存率差密切相关（对数秩检验 p<0.001）。通过 Cox 回归分析校正 APACHE Ⅱ评分后，最大化学发光强度被确定为 28 天死亡率概率的独立预测因子。
入院时测量的最大化学发光强度水平似乎对脓毒症患者的死亡率具有较高的预测价值。
