Røsjø Helge, Stridsberg Mats, Ottesen Anett H, Nygård Ståle, Christensen Geir, Pettilä Ville, Linko Rita, Karlsson Sari, Varpula Tero, Ruokonen Esko, Omland Torbjørn
1Division of Medicine, Akershus University Hospital, Lørenskog, Norway.2Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.3Department of Medical Sciences, Uppsala University, Uppsala, Sweden.4Institute for Experimental Medical Research, Oslo University Hospital, Oslo, Norway.5Bioinformatics core facility, University of Oslo and Oslo University Hospital, Oslo, Norway.6Department of Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.7Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.8Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland.9Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland.
Crit Care Med. 2016 Oct;44(10):1882-90. doi: 10.1097/CCM.0000000000001832.
Secretoneurin is produced in neuroendocrine cells, and the myocardium and circulating secretoneurin levels provide incremental prognostic information to established risk indices in cardiovascular disease. As myocardial dysfunction contributes to poor outcome in critically ill patients, we wanted to assess the prognostic value of secretoneurin in two cohorts of critically ill patients with infections.
Two prospective, observational studies.
Twenty-four and twenty-five ICUs in Finland.
A total of 232 patients with severe sepsis (cohort #1) and 94 patients with infections and respiratory failure (cohort #2).
None.
We measured secretoneurin levels by radioimmunoassay in samples obtained early after ICU admission and compared secretoneurin with other risk indices. In patients with severe sepsis, admission secretoneurin levels (logarithmically transformed) were associated with hospital mortality (odds ratio, 3.17 [95% CI, 1.12-9.00]; p = 0.030) and shock during the hospitalization (odds ratio, 2.17 [1.06-4.46]; p = 0.034) in analyses that adjusted for other risk factors available on ICU admission. Adding secretoneurin levels to age, which was also associated with hospital mortality in the multivariate model, improved the risk prediction as assessed by the category-free net reclassification index: 0.35 (95% CI, 0.06-0.64) (p = 0.02). In contrast, N-terminal pro-B-type natriuretic peptide levels were not associated with mortality in the multivariate model that included secretoneurin measurements, and N-terminal pro-B-type natriuretic peptide did not improve patient classification on top of age. Secretoneurin levels were also associated with hospital mortality after adjusting for other risk factors and improved patient classification in cohort #2. In both cohorts, the optimal cutoff for secretoneurin levels at ICU admission to predict hospital mortality was ≈ 175 pmol/L, and higher levels were associated with mortality also when adjusting for Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores.
Secretoneurin levels provide incremental information to established risk indices for the prediction of mortality and shock in critically ill patients with severe infections.
促分泌素原在神经内分泌细胞中产生，心肌和循环中的促分泌素原水平可为心血管疾病已有的风险指标提供额外的预后信息。由于心肌功能障碍会导致重症患者预后不良，我们想评估促分泌素原在两组感染性重症患者中的预后价值。
两项前瞻性观察性研究。
芬兰的24个和25个重症监护病房。
共有232例严重脓毒症患者（队列1）和94例感染并呼吸衰竭患者（队列2）。
无。
我们通过放射免疫分析法测定了重症监护病房入院后早期采集样本中的促分泌素原水平，并将促分泌素原与其他风险指标进行比较。在严重脓毒症患者中，在对重症监护病房入院时可用的其他风险因素进行校正的分析中，入院时促分泌素原水平（对数转换）与住院死亡率（比值比，3.17 [95%可信区间，1.12 - 9.00]；p = 0.030）及住院期间休克（比值比，2.17 [1.06 - 4.46]；p = 0.034）相关。在多变量模型中，将促分泌素原水平加入到同样与住院死亡率相关的年龄因素中，根据无类别净重新分类指数评估，改善了风险预测：0.35（95%可信区间，0.06 - 0.64）（p = 0.02）。相比之下，在包含促分泌素原测量值的多变量模型中，N末端B型利钠肽原水平与死亡率无关，且在年龄基础上，N末端B型利钠肽原并未改善患者分类。在对其他风险因素进行校正后，促分泌素原水平也与队列2中的住院死亡率相关，并改善了患者分类。在两个队列中，重症监护病房入院时促分泌素原水平预测住院死亡率的最佳截断值约为175 pmol/L，在对简化急性生理学评分II和序贯器官衰竭评估评分进行校正时，更高水平也与死亡率相关。
促分泌素原水平可为已有的风险指标提供额外信息，用于预测严重感染的重症患者的死亡率和休克情况。
