Lundberg Oscar H M, Bergenzaun Lill, Rydén Jörgen, Rosenqvist Mari, Melander Olle, Chew Michelle S
Department of Intensive- and perioperative care, Skåne University Hospital Malmö, Inga Marie Nilssons gata 47, S-205 02, Malmö, Sweden.
Department of Infectious diseases, Skåne University Hospital Malmö, Ruth Lundskogs gata 3, S-205 02, Malmö, Sweden.
Crit Care. 2016 Jun 9;20(1):178. doi: 10.1186/s13054-016-1361-y.
Adrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care. We investigated the relationship between mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), and myocardial injury, measured using transthoracic echocardiography and hsTNT in septic shock patients. We were also interested in the development of different biomarkers throughout the ICU stay, and how early measurements were related to mortality. Further, we assessed if a positive biomarker panel, consisting of MR-proADM, CT-proET-1, and hsTNT changed the odds for mortality.
A cohort of 53 consecutive patients with septic shock had their levels of MR-proADM, CT-proET-1, hsTNT, and left ventricular systolic functions prospectively measured over 7 days. The relationship between day 1 levels of MR-proADM/CT-proET-1 and myocardial injury was studied. We also investigated the relationship between biomarkers and early (7-day) and later (28-day) mortality. Likelihood ratios, and pretest and posttest odds for mortality were calculated.
Levels of MR-proADM and CT-proET-1 were significantly higher among patients with myocardial injury and were correlated with left ventricular systolic dysfunction. MR-proADM and hsTNT were significantly higher among 7-day and 28-day non-survivors. CT-proET-1 was also significantly higher among 28-day but not 7-day non-survivors. A positive biomarker panel consisting of the three biomarkers increased the odds for mortality 13-fold to 20-fold.
MR-proADM and CT-proET-1 are associated with myocardial injury. A biomarker panel combining MR-proADM, CT-proET-1, and hsTNT increases the odds ratio for death, and may improve currently available scoring systems in critical care.
肾上腺髓质素和内皮素-1是对心血管系统具有相反作用的激素。肾上腺髓质素作为一种血管舒张剂，似乎对脓毒症高动力循环反应的启动和持续很重要。内皮素-1是一种血管收缩剂，与心脏功能下降有关。很少有研究探讨肾上腺髓质素与内皮素-1之间的关系以及脓毒性休克患者的发病率和死亡率。高敏肌钙蛋白T（hsTNT）通常用于诊断急性心脏损伤，但对重症监护的预后也有预测价值。我们研究了脓毒性休克患者中使用经胸超声心动图和hsTNT测量的中段肾上腺髓质素原（MR-proADM）、C端内皮素-1原（CT-proET-1）与心肌损伤之间的关系。我们还对整个重症监护病房（ICU）住院期间不同生物标志物的变化情况以及早期测量与死亡率的关系感兴趣。此外，我们评估了由MR-proADM、CT-proET-1和hsTNT组成的阳性生物标志物组合是否会改变死亡几率。
对53例连续性脓毒性休克患者在7天内前瞻性测量其MR-proADM、CT-proET-1、hsTNT水平以及左心室收缩功能。研究第1天MR-proADM/CT-proET-1水平与心肌损伤之间的关系。我们还研究了生物标志物与早期（7天）和晚期（28天）死亡率之间的关系。计算了死亡的似然比以及死亡的验前概率和验后概率。
心肌损伤患者的MR-proADM和CT-proET-1水平显著更高，且与左心室收缩功能障碍相关。在7天和28天的非存活患者中，MR-proADM和hsTNT显著更高。在28天而非7天的非存活患者中，CT-proET-1也显著更高。由这三种生物标志物组成的阳性生物标志物组合使死亡几率增加了13倍至20倍。
MR-proADM和CT-proET-1与心肌损伤有关。由MR-proADM、CT-proET-1和hsTNT组成的生物标志物组合增加了死亡比值比，可能会改善目前重症监护中可用的评分系统。
