血清黏附分子作为急诊科需要机械通气的成年严重脓毒症患者预后的预测指标
Serum adhesion molecules as outcome predictors in adult severe sepsis patients requiring mechanical ventilation in the emergency department.
作者信息
Kung Chia-Te, Su Chih-Min, Chang Hsueh-Wen, Cheng Hsien-Hung, Hsiao Sheng-Yuan, Tsai Tsung-Cheng, Chang Wen-Neng, Tsai Nai-Wen, Wang Hung-Chen, Su Yu-Jih, Huang Chin-Cheng, Lin Wei-Che, Cheng Ben-Chung, Chang Ya-Ting, Chiang Yi-Fang, Lu Cheng-Hsien
机构信息
Departments of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Departments of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
出版信息
Clin Biochem. 2014 Oct;47(15):38-43. doi: 10.1016/j.clinbiochem.2014.06.020. Epub 2014 Jul 3.
BACKGROUND AND AIM
Serum adhesion molecules play a pivotal role in the pathogenesis of sepsis syndrome. This study aimed to evaluate the prognostic value of serum adhesion molecules in patients with severe sepsis and mechanical ventilation (MV) at the emergency department.
METHODS
Eighty-seven consecutive patients with severe sepsis, including 35 with MV, were evaluated. Serum samples were collected for analysis of serum adhesion molecules. The patients' clinical and laboratory data on admission were also recorded.
RESULTS
The maximum 24-h APACHE II and 24-h SOFA scores were significantly higher in the severe sepsis patients requiring MV than in patients without MV (p=0.02 and p<0.001). Mortality rate was significantly higher in severe sepsis patients requiring MV than in patients without MV (40% [14/35] vs. 9.6% [5/52], p=0.001). Both VCAM-1 level (p=0.03) and lactate concentration (p=0.04) on admission had significant differences between survivors and non-survivors in patients requiring MV. In the logistic regression model, only VCAM-1 level (p=0.049) was independently predictive of mortality. By correlation analysis, lactate concentration significantly correlated with the mean VCAM-1 level on admission (γ=0.484, p=0.004). The area under the ROC curve for VCAM-1 level was 0.747 (p=0.02, 95% CI: 0.576-0.918). The cut-off value of VCAM-1 level for predicting hospital mortality in severe sepsis patients receiving MV was 1870ng/mL, with 77% sensitivity and 71% specificity; then the likelihood ratio equals 2.7.
CONCLUSIONS
In this study, VCAM-1 level is a more powerful outcome predictor of hospital mortality in severe sepsis patients requiring MV than lactate concentration and other conventional parameters on admission. This suggests that increased plasma VCAM-1 concentration may be useful in identifying who are at risk of hospital mortality among severely septic patients requiring MV.
背景与目的
血清黏附分子在脓毒症综合征的发病机制中起关键作用。本研究旨在评估血清黏附分子对急诊科严重脓毒症且接受机械通气（MV）患者的预后价值。
方法
对87例连续的严重脓毒症患者进行评估，其中35例接受MV。采集血清样本以分析血清黏附分子。记录患者入院时的临床和实验室数据。
结果
需要MV的严重脓毒症患者的24小时最高APACHE II评分和24小时SOFA评分显著高于未接受MV的患者（p = 0.02和p < 0.001）。需要MV的严重脓毒症患者的死亡率显著高于未接受MV的患者（40% [14/35] 对9.6% [5/52]，p = 0.001）。在需要MV的患者中，幸存者和非幸存者入院时的血管细胞黏附分子-1（VCAM-1）水平（p = 0.03）和乳酸浓度（p = 0.04）均存在显著差异。在逻辑回归模型中，只有VCAM-1水平（p = 0.049）可独立预测死亡率。通过相关性分析，乳酸浓度与入院时的平均VCAM-1水平显著相关（γ = 0.484，p = 0.004）。VCAM-1水平的ROC曲线下面积为0.747（p = 0.02，95% CI：0.576 - 0.918）。接受MV的严重脓毒症患者预测医院死亡率的VCAM-1水平临界值为1870ng/mL，敏感性为77%，特异性为71%；似然比为2.7。
结论
在本研究中，对于需要MV的严重脓毒症患者，VCAM-1水平比乳酸浓度和其他入院时的传统参数更能有力地预测医院死亡率。这表明血浆VCAM-1浓度升高可能有助于识别需要MV的严重脓毒症患者中存在医院死亡风险的患者。
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