可溶性CD14亚型（前降钙素）在重症监护治疗第一周对严重脓毒症和脓毒性休克的诊断及预后评估价值
Diagnostic and prognostic utility of soluble CD 14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment.
作者信息
Behnes Michael, Bertsch Thomas, Lepiorz Dominic, Lang Siegfried, Trinkmann Frederik, Brueckmann Martina, Borggrefe Martin, Hoffmann Ursula
出版信息
Crit Care. 2014 Sep 5;18(5):507. doi: 10.1186/s13054-014-0507-z.
INTRODUCTION
The aim of this study was to evaluate the diagnostic and prognostic value of presepsin in patients with severe sepsis and septic shock during the first week of ICU treatment.
METHODS
In total, 116 patients with suspected severe sepsis or septic shock were included during the first 24 hours of ICU treatment. Blood samples for biomarker measurements of presepsin, procalcitonin (PCT), interleukin 6 (IL-6), C reactive protein (CRP) and white blood cells (WBC) were drawn at days 1, 3 and 8. All patients were followed up for six months. Biomarkers were tested for diagnosis of sepsis, severe sepsis, septic shock and for prognosis of 30-days and 6-months all-cause mortality at days 1, 3 and 8. Diagnostic and prognostic utilities were tested by determining diagnostic cutoff levels, goodness criteria, C-statistics and multivariable Cox regression models.
RESULTS
Presepsin increased significantly from the lowest to most severe sepsis groups at days 1, 3 and 8 (test for linear trend P <0.03). Presepsin levels revealed valuable diagnostic capacity to diagnose severe sepsis and septic shock at days 1, 3 and 8 (range of diagnostic area under the curves (AUC) 0.72 to 0.84, P = 0.0001) compared to IL-6, PCT, CRP and WBC. Goodness criteria for diagnosis of sepsis severity were analyzed (≥sepsis, cutoff = 530 pg/ml; ≥severe sepsis, cutoff = 600 pg/ml; ≥septic shock, cutoff = 700 pg/ml; P <0.03). Presepsin levels revealed significant prognostic value for 30 days and 6 months all-cause mortality (presepsin: range of AUC 0.64 to 0.71, P <0.02). Patients with presepsin levels of the 4th quartile were 5 to 7 times more likely to die after six months than patients with lower levels. The prognostic value for all-cause mortality of presepsin was comparable to that of IL-6 and better than that of PCT, CRP or WBC.
CONCLUSIONS
In patients with suspected severe sepsis and septic shock, presepsin reveals valuable diagnostic capacity to differentiate sepsis severity compared to PCT, IL-6, CRP, WBC. Additionally, presepsin and IL-6 reveal prognostic value with respect to 30 days and 6 months all-cause mortality throughout the first week of ICU treatment.
TRIAL REGISTRATION
ClinicalTrials.gov http://NCT01535534. Registered 14 February 2012.
引言
本研究的目的是评估在重症监护病房（ICU）治疗的第一周，可溶性髓系细胞触发受体-1（presepsin）对严重脓毒症和脓毒性休克患者的诊断及预后价值。
方法
共有116例疑似严重脓毒症或脓毒性休克患者在ICU治疗的最初24小时内被纳入研究。在第1、3和8天采集血液样本，用于检测presepsin、降钙素原（PCT）、白细胞介素6（IL-6）、C反应蛋白（CRP）和白细胞（WBC）等生物标志物。所有患者均随访6个月。在第1、3和8天，对生物标志物进行检测，以诊断脓毒症、严重脓毒症、脓毒性休克，并评估30天和6个月全因死亡率的预后情况。通过确定诊断临界值、优度标准、C统计量和多变量Cox回归模型来测试诊断和预后效用。
结果
在第1、3和8天，从脓毒症最轻组到最严重组，presepsin显著升高（线性趋势检验P<0.03）。与IL-6、PCT、CRP和WBC相比，presepsin水平在第1、3和8天显示出诊断严重脓毒症和脓毒性休克的有价值的诊断能力（曲线下面积（AUC）范围为0.72至0.84，P = 0.0001）。分析了脓毒症严重程度诊断的优度标准（≥脓毒症，临界值=530 pg/ml；≥严重脓毒症，临界值=600 pg/ml；≥脓毒性休克，临界值=700 pg/ml；P<0.03）。presepsin水平显示出对30天和6个月全因死亡率的显著预后价值（presepsin：AUC范围为0.64至0.71，P<0.02）。处于第4四分位数presepsin水平的患者在6个月后死亡的可能性是较低水平患者的5至7倍。presepsin对全因死亡率的预后价值与IL-6相当，且优于PCT、CRP或WBC。
结论
在疑似严重脓毒症和脓毒性休克患者中，与PCT、IL-6、CRP、WBC相比，presepsin显示出区分脓毒症严重程度的有价值的诊断能力。此外，在ICU治疗的第一周，presepsin和IL-6在30天和6个月全因死亡率方面显示出预后价值。
试验注册
ClinicalTrials.gov http://NCT01535534。2012年2月14日注册。
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