Palud Aurore, Parmentier-Decrucq Erika, Pastre Jean, De Freitas Caires Nathalie, Lassalle Philippe, Mathieu Daniel
CHRU Lille, Hôpital Salengro, F-59037 Lille, France; Universite Lille Nord de France, F-59000 Lille, France.
CHRU Lille, Hôpital Salengro, F-59037 Lille, France.
Cytokine. 2015 Jun;73(2):213-8. doi: 10.1016/j.cyto.2015.02.013. Epub 2015 Mar 17.
Endothelial injury is recognized to trigger organ failures during the first 48h of septic shock. We evaluate endothelial biomarkers at ICU admission in their ability to predict severity, outcome, and organ failures in septic shock patients.
This prospective observational pilot study was conducted in a medical intensive care unit of a university hospital. Plasma levels of endothelial biomarkers as angiopoietin-2, sE-selectin or endocan were measured at ICU admission of 20 patients presenting with septic shock. Clinical and biological data were recorded at inclusion and each day during the first week.
Significant correlations were found between angiopoietin-2 and severity scores at Day 1: SAPS2 (r(2)=0.620; p=0.004) and LOD score (r(2)=0.681; p=0.001). The angiopoietin-2 level was significantly higher in patients presenting with organ failure such as hemodynamic, renal or hepatic failure. It correlated with catecholamine infusion dose and was higher in non survivors compared with survivors (33.5 [28.9-51.4] vs. 12.4 [6.4-14.7]ng/ml; p=0.001). In contrast, in that population presenting with septic shock, endocan level at inclusion was not related to any organ failure at inclusion or Day 1 but appeared lower in patients presenting with respiratory failure at Day 3 compared to those who do not (1.9 [0.99-3.1] vs 5.2 [3.1-17.2]ng/ml; p=0.032). The endocan level at inclusion was correlated with the decrease in PaO2/FiO2 ratio at Day 2 (r(2)=0.628; p=0.0004) and Day 3 (r(2)=0.645; p=0.005). Endocan level <2.54ng/ml at admission is predictive of a respiratory failure presence at Day 3.
In septic shock patients, angiopoietine-2 is related with clinical severity during the first 24h but only endocan is able to predict the presence of respiratory failure at Day 3.
内皮损伤被认为是在脓毒性休克的最初48小时内引发器官功能衰竭的原因。我们评估脓毒性休克患者入住重症监护病房（ICU）时内皮生物标志物预测病情严重程度、预后及器官功能衰竭的能力。
这项前瞻性观察性试验研究在一家大学医院的内科重症监护病房进行。对20例脓毒性休克患者入住ICU时的血浆内皮生物标志物水平进行检测，包括血管生成素-2、可溶性E选择素（sE-选择素）或内脂素。在纳入研究时及第一周的每一天记录临床和生物学数据。
在第1天，血管生成素-2与病情严重程度评分之间存在显著相关性：简化急性生理学评分系统Ⅱ（SAPS2）（r² = 0.620；p = 0.004）和逻辑器官功能障碍评分（LOD评分）（r² = 0.681；p = 0.001）。在出现诸如血流动力学、肾脏或肝脏功能衰竭等器官功能衰竭的患者中，血管生成素-2水平显著更高。它与儿茶酚胺输注剂量相关，与幸存者相比，非幸存者中的水平更高（33.5 [28.9 - 51.4]对12.4 [6.4 - 14.7] ng/ml；p = 0.001）。相比之下，在该脓毒性休克患者群体中，纳入研究时内脂素水平与纳入时或第1天的任何器官功能衰竭均无关，但在第3天出现呼吸衰竭的患者中，其水平低于未出现呼吸衰竭的患者（1.9 [0.99 - 3.1]对5.2 [3.1 - 17.2] ng/ml；p = 0.032）。纳入研究时内脂素水平与第2天（r² = 0.628；p = 0.0004）和第3天（r² = 0.645；p = 0.005）的动脉血氧分压/吸入氧分数（PaO₂/FiO₂）比值下降相关。入院时内脂素水平<2.54 ng/ml可预测第3天呼吸衰竭的发生。
在脓毒性休克患者中，血管生成素-2与最初24小时内的临床严重程度相关，但只有内脂素能够预测第3天呼吸衰竭的发生。
