中性粒细胞明胶酶相关脂质运载蛋白升高与严重脓毒症和脓毒性休克的死亡率及多器官功能障碍综合征相关。

Increased Neutrophil Gelatinase-Associated Lipocalin is Associated with Mortality and Multiple Organ Dysfunction Syndrome in Severe Sepsis and Septic Shock.

作者信息

Wang Biao, Chen Gang, Zhang Jun, Xue Jiping, Cao Yifei, Wu Yunfu

机构信息

Department of Critical Care Medicine, The Affiliated Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China.

出版信息

Shock. 2015 Sep;44(3):234-8. doi: 10.1097/SHK.0000000000000408.

DOI:10.1097/SHK.0000000000000408

PMID:26009825

Abstract

BACKGROUND

This study examines the clinical utility of increased neutrophil gelatinase-associated lipocalin (NGAL) as an indicator of mortality and multiple organ dysfunction syndrome (MODS) in severe sepsis and septic shock.

METHODS

We designed a prospective cohort study in an intensive care unit, and 123 patients with severe sepsis or septic shock were included. Data were used to determine a relationship between NGAL and the development of MODS and mortality. These associations were determined by the Mann-Whitney U test, log-rank test, Cox proportional hazards regression analyses, and plotting the receiver operating characteristic curve.

RESULTS

Patients with high NGAL (75th percentile) had increased risk of mortality and MODS compared with patients with low NGAL (log-rank test, P < 0.05). There were 39 patients (32%) with mortality during follow-up at 12 months, 10 patients (8%) with MODS on day 1, and 37 patients (30%) on day 7. The area under the receiver operating characteristic curve showed that high NGAL could predict mortality (0.6385) during intensive care unit stay. After adjustment for confounding risk factors chosen by backward elimination by Cox regression analysis, high NGAL remained an independent predictor of mortality and MODS (hazard ratios, 2.128 [95% confidence interval, 1.078-4.203; P = 0.030] and 1.896 [95% confidence interval, 1.012-3.552; P = 0.046], respectively).

CONCLUSIONS

High plasma NGAL independently predicts mortality and MODS in severe sepsis and septic shock.

摘要

背景

本研究探讨中性粒细胞明胶酶相关脂质运载蛋白（NGAL）升高作为严重脓毒症和脓毒性休克患者死亡率及多器官功能障碍综合征（MODS）指标的临床实用性。

方法

我们在重症监护病房设计了一项前瞻性队列研究，纳入123例严重脓毒症或脓毒性休克患者。利用数据确定NGAL与MODS发生及死亡率之间的关系。通过Mann-Whitney U检验、对数秩检验、Cox比例风险回归分析以及绘制受试者工作特征曲线来确定这些关联。

结果

与低NGAL患者相比，高NGAL（第75百分位数）患者的死亡风险和发生MODS的风险增加（对数秩检验，P<0.05）。随访12个月期间有39例患者（32%）死亡，第1天有10例患者（8%）发生MODS，第7天有37例患者（3%)发生MODS。受试者工作特征曲线下面积显示，高NGAL可预测重症监护病房住院期间的死亡率（0.6385）。经Cox回归分析采用向后剔除法选择混杂风险因素进行校正后，高NGAL仍然是死亡率和MODS的独立预测因素（风险比分别为2.128[95%置信区间为1.078 - 4.203；P = 0.030]和1.896[95%置信区间为1.012 - 3.552；P = 0.0并46]）。