Bomberg Hagen, Klingele Matthias, Wagenpfeil Stefan, Spanuth Eberhard, Volk Thomas, Sessler Daniel I, Schäfers Hans-Joachim, Groesdonk Heinrich Volker
From the Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine (H.B., T.V., H.V.G.); Division of Nephrology and Hypertension, Department of Medicine (M.K.), Institute for Medical Biometry, Epidemiology, and Medical Informatics (S.W.), and Department of Thoracic and Cardiovascular Surgery (H.-J.S.), Saarland University, University Medical Centre, Homburg/Saar, Germany; DIAneering-Diagnostics Engineering & Research GmbH, Heidelberg, Germany (E.S.); and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.).
Anesthesiology. 2017 Apr;126(4):631-642. doi: 10.1097/ALN.0000000000001522.
Presepsin (soluble cluster-of-differentiation 14 subtype [sCD14-ST]) is a humoral risk stratification marker for systemic inflammatory response syndrome and sepsis. It remains unknown whether presepsin can be used to stratify risk in elective cardiac surgery. The authors therefore determined the usefulness of presepsin for risk stratification in patients having elective cardiac surgery.
Eight hundred fifty-six cardiac surgical patients were prospectively studied. Preoperative plasma concentrations of presepsin, procalcitonin, N-terminal pro-hormone natriuretic peptide, cystatin C, and the additive European System of Cardiac Operative Risk Evaluation 2 were compared to mortality at 30 days (primary outcome), 6 months, and 2 yr. Discrimination was assessed with C statistic. Logistic regression analysis was used to calculate univariable and multivariable odds ratios.
Thirty-day mortality was 3.2%, 6-month mortality was 6.1%, and 2-yr mortality was 10.4% across the population. Median preoperative presepsin concentrations were significantly greater in 30-day nonsurvivors than in survivors: 842 pg/ml (interquartile range, 306 to 1,246) versus 160 pg/ml (interquartile range, 122 to 234); difference, 167 pg/ml (interquartile range, 92 to 301; P < 0.001). The results were similar for 6-month and 2-yr mortality. Compared to the European System of Cardiac Operative Risk Evaluation 2, presepsin concentration provided better discrimination for postoperative mortality at all follow-up periods, including 30 days (C statistic 0.88 vs. 0.74), 6 months (0.87 vs. 0.76), and 2 yr (0.81 vs. 0.74). Presepsin also provided better discrimination than cystatin C, N-terminal pro-hormone natriuretic peptide, or procalcitonin. Elevated presepsin remained an independent risk predictor after adjustment for potential confounding factors.
Elevated preoperative plasma presepsin concentration is an independent predictor of postoperative mortality in elective cardiac surgery patients and is a stronger predictor than several other commonly used assessments.
可溶性分化簇14亚型（sCD14-ST）即可溶性髓系细胞触发受体-1（presepsin）是全身炎症反应综合征和脓毒症的一种体液风险分层标志物。目前尚不清楚presepsin是否可用于择期心脏手术的风险分层。因此，作者确定了presepsin在择期心脏手术患者风险分层中的实用性。
对856例心脏手术患者进行前瞻性研究。将术前血浆中presepsin、降钙素原、N末端脑钠肽前体、胱抑素C的浓度以及欧洲心脏手术风险评估系统2（EuroSCORE 2）与30天（主要结局）、6个月和2年时的死亡率进行比较。用C统计量评估辨别力。采用逻辑回归分析计算单变量和多变量比值比。
整个人群的30天死亡率为3.2%，6个月死亡率为6.1%，2年死亡率为10.4%。30天内死亡患者术前presepsin浓度中位数显著高于存活患者：842 pg/ml（四分位间距，306至1246）对比160 pg/ml（四分位间距，122至234）；差值为167 pg/ml（四分位间距，92至301；P<0.001）。6个月和2年死亡率的结果相似。与欧洲心脏手术风险评估系统2相比，presepsin浓度在所有随访期（包括30天（C统计量0.88对0.74）、六个月（0.87对0.76）和2年（0.81对0.74））对术后死亡率的辨别力更好。Presepsin的辨别力也优于胱抑素C、N末端脑钠肽前体或降钙素原。在对潜在混杂因素进行校正后，presepsin升高仍然是独立的风险预测指标。
术前血浆presepsin浓度升高是择期心脏手术患者术后死亡的独立预测指标，且比其他几种常用评估指标的预测性更强。
