Emergency Department of Beijing Chaoyang Hospital, Capital Medical University, 8# Worker's Stadium South Road, Beijing, 100020, China.
Thromb Res. 2013 Oct;132(4):471-6. doi: 10.1016/j.thromres.2013.08.011. Epub 2013 Aug 28.
Soluble thrombomodulin (sTM) is a sensitive marker of endothelial damage. In this study we investigated the role of sTM in the evaluation of the severity and prognosis of septic patients in the emergency department (ED).
A prospective, observational cohort study was performed in the ED of an urban, university hospital. Patients who had suspected infection with two or more criteria of systemic inflammatory response syndrome were consecutively enrolled. sTM, D-Dimer and procalcitonin levels were measured on enrollment, and the Mortality in Emergency Department Sepsis (MEDS) score was calculated. A 30-day follow-up was performed for all patients.
A total of 372 patients with sepsis, 210 patients with severe sepsis and 98 patients with septic shock were enrolled in this study. According to the disease severity, patients were divided into sepsis subgroup and severe sepsis subgroup (including septic shock). In addition, patients were divided into survivors subgroup and non-survivors subgroup according to the 30-day mortality. Plasma sTM levels in patients with severe sepsis were higher than those with sepsis (P<0.001). Compared with survivors, non-survivors has higher plasma sTM levels (P<0.001). Multivariate logistic regression analysis showed that sTM was an independent predictor of severe sepsis (odds ratio 1.11) and 30-day mortality (odds ratio 1.059). Receiver operating characteristic curve analysis showed that sTM was a useful parameter in prediction of severe sepsis (0.859) and 30-day mortality (0.78). Compared with the MEDS score alone, combination of sTM and the MEDS score can improve the accuracy in prediction of severe sepsis and 30-day mortality.
sTM is a valuable biomarker in the risk stratification and prognosis evaluation of ED sepsis. Furthermore, sTM can enhance the ability of the MEDS score in prediction of severe sepsis and 30-day mortality.
可溶性血栓调节蛋白（sTM）是内皮损伤的敏感标志物。本研究旨在探讨 sTM 在评估急诊科（ED）脓毒症患者严重程度和预后中的作用。
本前瞻性观察队列研究在一所城市大学医院的 ED 进行。连续纳入符合感染且全身炎症反应综合征（SIRS）两项或多项标准的疑似感染患者。患者入组时检测 sTM、D-二聚体和降钙素原水平，并计算病死率急诊脓毒症评分（MEDS）。对所有患者进行 30 天随访。
本研究共纳入 372 例脓毒症患者，其中 210 例严重脓毒症患者和 98 例脓毒性休克患者。根据疾病严重程度，患者分为脓毒症亚组和严重脓毒症亚组（包括脓毒性休克）。此外，根据 30 天死亡率，患者分为存活亚组和死亡亚组。严重脓毒症患者的血浆 sTM 水平高于脓毒症患者（P<0.001）。与存活者相比，死亡者的血浆 sTM 水平更高（P<0.001）。多因素 logistic 回归分析显示，sTM 是严重脓毒症（优势比 1.11）和 30 天死亡率（优势比 1.059）的独立预测因子。受试者工作特征曲线分析显示，sTM 是预测严重脓毒症（0.859）和 30 天死亡率（0.78）的有用参数。与 MEDS 评分单独比较，sTM 与 MEDS 评分联合应用可提高严重脓毒症和 30 天死亡率预测的准确性。
sTM 是 ED 脓毒症患者风险分层和预后评估的有价值的生物标志物。此外，sTM 可增强 MEDS 评分预测严重脓毒症和 30 天死亡率的能力。
