Chen Yun-Xia, Li Chun-Sheng
Emergency Department of Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China.
Emergency Department of Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China.
J Crit Care. 2014 Aug;29(4):512-6. doi: 10.1016/j.jcrc.2014.03.026. Epub 2014 Apr 2.
To evaluate the prognostic and risk-stratified ability of heart-type fatty acid-binding protein (H-FABP) in septic patients in the emergency department (ED).
From August to November 2012, 295 consecutive septic patients were enrolled. Circulating H-FABP was measured. The predictive value of H-FABP for 28-day mortality, organ dysfunction on ED arrival, and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was assessed by the receiver operating characteristic curve and logistic regression and was compared with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Mortality in Emergency Department Sepsis (MEDS) score, and Sequential Organ Failure Assessment score.
The 28-day mortality, APACHE II, MEDS, and Sequential Organ Failure Assessment scores were much higher in H-FABP-positive patients. The incidence of organ dysfunction at ED arrival and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was higher in H-FABP-positive patients. Heart-type fatty acid-binding protein was an independent predictor of 28-day mortality and organ dysfunction. The area under the receiver operating characteristic curve for H-FABP predicting 28-day mortality and organ dysfunction was 0.784 and 0.755, respectively. Combination of H-FABP and MEDS improved the performance of MEDS in predicting organ dysfunction, and the difference of AUC was statistically significant (P<.05). The combinations of H-FABP and MEDS or H-FABP and APACHE II also improved the prognostic value of MEDS and APACHE II, but the areas under the curve were not statistically different.
Heart-type fatty acid-binding protein was helpful for prognosis and risk stratification of septic patients in the ED.
评估心型脂肪酸结合蛋白（H-FABP）对急诊科（ED）脓毒症患者的预后及风险分层能力。
2012年8月至11月，连续纳入295例脓毒症患者。检测循环H-FABP水平。通过受试者工作特征曲线和逻辑回归评估H-FABP对28天死亡率、急诊入院时器官功能障碍以及急诊入院后6小时内机械通气或血管活性药物使用需求的预测价值，并与急性生理与慢性健康状况评估（APACHE）II评分、急诊科脓毒症死亡率（MEDS）评分及序贯器官衰竭评估评分进行比较。
H-FABP阳性患者的28天死亡率、APACHE II评分、MEDS评分及序贯器官衰竭评估评分均显著更高。H-FABP阳性患者急诊入院时器官功能障碍的发生率以及急诊入院后6小时内机械通气或血管活性药物使用需求更高。心型脂肪酸结合蛋白是28天死亡率和器官功能障碍的独立预测因素。H-FABP预测28天死亡率和器官功能障碍的受试者工作特征曲线下面积分别为0.784和0.755。H-FABP与MEDS联合使用可提高MEDS对器官功能障碍的预测性能，且曲线下面积差异具有统计学意义（P<0.05）。H-FABP与MEDS或H-FABP与APACHE II联合使用也可提高MEDS和APACHE II的预后价值，但曲线下面积无统计学差异。
心型脂肪酸结合蛋白有助于急诊科脓毒症患者的预后评估和风险分层。
