Lorente Leonardo, Martín María M, Pérez-Cejas Antonia, López Raquel Ortiz, Ferreres José, Solé-Violán Jordi, Labarta Lorenzo, Díaz César, Palmero Salomé, Buitrago Manuel, Jiménez Alejandro, Borreguero-León Juan M
.
Clin Chem Lab Med. 2017 Aug 28;55(10):1621-1629. doi: 10.1515/cclm-2016-1034.
Caspase-cleaved cytokeratin (CCCK)-18 is a protein released into the blood during apoptosis. Higher circulating CCCK-18 concentrations have been found in non-survivor than in survivor septic patients at moment of sepsis diagnosis. The following questions arise now: (1) How are serum CCCK-18 levels during the first week of sepsis? (2) Is there an association between sepsis severity and mortality and serum CCCK-18 levels during the first week? The aims of this study were to answer these questions.
Multicenter study with 321 severe septic patients from eight Spanish intensive care units. We determined serum concentration of CCCK-18, tumor necrosis factor (TNF)-α, and interleukin (IL)-10 during the first week. Our end-point study was 30-day mortality.
Non-survivor (n=108) compared to survivor patients (n=213) showed higher serum CCCK-18 levels at days 1, 4 and 8 (p<0.001). ROC curve analyses showed that serum CCCK-18 levels at days 1 (AUC=0.77; 95% CI=0.72-0.82), 4 (AUC=0.81; 95% CI=0.76-0.85) and 8 (AUC=0.83; 95% CI=0.78-0.88) could predict mortality at 30 days (p<0.001). Logistic regression analyses showed that serum CCCK-18 levels at days 1 (OR=4.367; 95% CI=2.491-7.659), 4 (OR=10.137; 95% CI=4.741-21.678) and 8 (OR=8.781; 95% CI=3.626-21.268) were associated with 30-day mortality (p<0.001). We found a positive correlation between CCCK-18, SOFA, and lactic acid at days 1, 4 and 8.
Non-survivor septic patients showed persistently during the first week higher serum CCCK-18 levels than survivor patients, and there is an association between sepsis severity and mortality and serum CCCK-18 levels during the first week.
半胱天冬酶切割的细胞角蛋白（CCCK）-18是细胞凋亡过程中释放到血液中的一种蛋白质。在脓毒症诊断时，已发现非存活脓毒症患者的循环CCCK-18浓度高于存活患者。现在出现了以下问题：（1）脓毒症第一周血清CCCK-18水平如何？（2）脓毒症严重程度和死亡率与第一周血清CCCK-18水平之间是否存在关联？本研究的目的是回答这些问题。
对来自西班牙8个重症监护病房的321例严重脓毒症患者进行多中心研究。我们测定了第一周内CCCK-18、肿瘤坏死因子（TNF）-α和白细胞介素（IL）-10的血清浓度。我们的终点研究是30天死亡率。
与存活患者（n=213）相比，非存活患者（n=108）在第1、4和8天的血清CCCK-18水平更高（p<0.001）。ROC曲线分析显示，第1天（AUC=0.77；95%CI=0.72-0.82）、第4天（AUC=0.81；95%CI=0.76-0.85）和第8天（AUC=0.83；95%CI=0.78-0.88）的血清CCCK-18水平可预测30天死亡率（p<0.001）。逻辑回归分析显示，第1天（OR=4.367；95%CI=2.491-7.659）、第4天（OR=10.137；95%CI=4.741-21.678）和第8天（OR=8.781；95%CI=3.626-21.268）的血清CCCK-18水平与30天死亡率相关（p<0.001）。我们发现第1、4和8天CCCK-18、序贯器官衰竭评估（SOFA）和乳酸之间存在正相关。
在第一周内，非存活脓毒症患者的血清CCCK-18水平持续高于存活患者，且脓毒症严重程度和死亡率与第一周血清CCCK-18水平之间存在关联。
