Ishikura Hiroyasu, Nishida Takeshi, Murai Akira, Nakamura Yoshihiko, Irie Yuhei, Tanaka Junichi, Umemura Takehiro
Crit Care. 2014 Jan 20;18(1):R19. doi: 10.1186/cc13700.
Inflammation and coagulation are closely interrelated pathophysiologic processes in the pathogenesis of sepsis. However, the diagnostic criteria of sepsis and disseminated intravascular coagulation (DIC) are different. This study aimed to define a biomarker panel to predict sepsis-induced DIC in emergency department patients.
Eighty-two patients who were admitted to the emergency department of a tertiary university hospital were included in this study. The inclusion criteria were as follows: (1) age >18 years; (2) ≥1 systemic inflammatory response syndrome (SIRS) criteria. Patients were excluded if they lacked biomarker data or apparent clinical manifestations. Eleven biomarkers were assayed from blood drawn on ED admission. Receiver operating curve (ROC) analysis including the area under the ROC and multivariable logistic regression were used to identify an optimal combination of biomarkers to create a diagnostic panel. The derived formula for weighting biomarker values was used to determine the severity of sepsis-induced DIC, which was divided into three categories: mild, moderate, and severe. We also investigated the ability of this classification to predict secondary outcome measures of rates of sepsis and DIC, DIC score, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure score (SOFA) score, and 28-day all-cause mortality.
Among the 11 biomarkers tested, the optimal 2-marker panel comprised presepsin and protein C. The area under the curve for the accuracies of predicting sepsis and DIC from these two biomarkers were 0.913 and 0.880, respectively. When patients were divided according to the severity of sepsis-induced DIC, all secondary outcomes except for mortality were significantly higher depending on the severity (P < .0001). The overall mortality rates of mild, moderate, and severe sepsis-induced DIC were 7.14%, 15.4%, and 28.6%, respectively (P = .0994).
A biomarker panel of presepsin and protein C is predictive of the severity of sepsis-induced DIC in suspected ED patients. These criteria for sepsis-induced DIC are very simple, easy to implement, and can be used in intensive care units as a point-of-care test.
炎症和凝血是脓毒症发病机制中密切相关的病理生理过程。然而，脓毒症和弥散性血管内凝血（DIC）的诊断标准不同。本研究旨在确定一个生物标志物组合，以预测急诊科患者的脓毒症诱导的DIC。
本研究纳入了一所三级大学医院急诊科收治的82例患者。纳入标准如下：（1）年龄>18岁；（2）≥1条全身炎症反应综合征（SIRS）标准。如果患者缺乏生物标志物数据或明显的临床表现，则将其排除。在急诊科入院时抽取的血液中检测了11种生物标志物。采用包括ROC曲线下面积和多变量逻辑回归的ROC分析来确定生物标志物的最佳组合，以创建一个诊断组合。用于加权生物标志物值的推导公式用于确定脓毒症诱导的DIC的严重程度，其分为轻度、中度和重度三类。我们还研究了这种分类预测脓毒症和DIC发生率、DIC评分、急性生理学与慢性健康状况评价（APACHE）II评分、序贯器官衰竭评分（SOFA）评分以及28天全因死亡率等次要结局指标的能力。
在检测的11种生物标志物中，最佳的双标志物组合包括可溶性髓系细胞触发受体-1（presepsin）和蛋白C。根据这两种生物标志物预测脓毒症和DIC的准确性的曲线下面积分别为0.913和0.88。当根据脓毒症诱导的DIC的严重程度对患者进行分组时，除死亡率外，所有次要结局根据严重程度均显著更高（P <.0001）。轻度、中度和重度脓毒症诱导的DIC的总体死亡率分别为7.14%、15.4%和28.6%（P = 0.0994）。
可溶性髓系细胞触发受体-1和蛋白C的生物标志物组合可预测疑似急诊科患者脓毒症诱导的DIC的严重程度。这些脓毒症诱导的DIC标准非常简单，易于实施，可在重症监护病房用作床旁检测。
