Azfar M Feroz, Khan M Faisal, Habib S Shahid, Aseri Z Al, Zubaidi A Mohammad, Aguila D Ocampo, Suriya M Owais, Ullah Hameed
Department of Critical Care, College of Medicine, King Saud University Medical City.
Clin Invest Med. 2017 Apr 26;40(2):E49-E58. doi: 10.25011/cim.v40i2.28195.
ADAMTS13 level was evaluated as a predictor of mortality in patients with severe sepsis and septic shock, and compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores.
This prospective observational study was conducted in the Medical and Surgical Intensive Care Units of King Khalid University Hospital. Detailed clinical evaluations were performed on 84 patients (56.08±18.18 years of age) with severe sepsis and septic shock. ADAMTS13 levels were determined (three blood samples at 24 hours intervals) and APACHE II scores, hematological profiles, indices of organ hypo-perfusion, renal functions and coagulation profiles were recorded. Primary outcome was 30 days ICU mortality and secondary outcomes were its comparison with APACHE II score, length of ICU stay and use of vasopressor agents.
Hypertension (53.6%) and diabetic mellitus (45.2%) were the commonest comorbidities. The median ADAMTS13 levels were 336.65, 339.35 and 313.9, respectively. ROC analysis showed maximum area under the curve for second ADAMTS13 (AUC=0.760) compared with first (AUC=0.660) and third samples (AUC=0.707) and APACHE II scores (AUC=0.662). Patients were divided into low and high ADAMTS13 groups according to the best cut-off point. Mortality was high in the low ADAMTS13 level group [OR=4.5]and was significantly associated with age, DBP, ADAMTS13, APACHE II score, DIC score and platelet count. ADAMTS13 (OR=5.3), APACHE II (OR=4.13) and DIC scores (OR=7.32) were significant risk factors for mortality.
Low ADAMTS13 was associated with increased mortality in patients with severe sepsis and septic shock and was comparable to APACHE II scores for predicting mortality.
评估ADAMTS13水平作为严重脓毒症和脓毒性休克患者死亡率的预测指标，并与急性生理与慢性健康状况评分系统II（APACHE II）评分进行比较。
这项前瞻性观察性研究在哈利德国王大学医院的内科和外科重症监护病房进行。对84例严重脓毒症和脓毒性休克患者（年龄56.08±18.18岁）进行了详细的临床评估。测定ADAMTS13水平（每隔24小时采集三份血样），并记录APACHE II评分、血液学指标、器官灌注不足指标、肾功能和凝血指标。主要结局为30天ICU死亡率，次要结局为其与APACHE II评分、ICU住院时间和血管升压药使用情况的比较。
高血压（53.6%）和糖尿病（45.2%）是最常见的合并症。ADAMTS13水平的中位数分别为336.65、339.35和313.9。ROC分析显示，与第一次（AUC=0.660）和第三次样本（AUC=0.707）以及APACHE II评分（AUC=0.662）相比，第二次ADAMTS13的曲线下面积最大（AUC=0.760）。根据最佳切点将患者分为ADAMTS13低水平组和高水平组。ADAMTS13低水平组死亡率较高[OR=4.5]，且与年龄、舒张压、ADAMTS13、APACHE II评分、DIC评分和血小板计数显著相关。ADAMTS13（OR=5.3）、APACHE II（OR=4.13）和DIC评分（OR=7.32）是死亡率的显著危险因素。
ADAMTS13水平低与严重脓毒症和脓毒性休克患者死亡率增加相关，在预测死亡率方面与APACHE II评分相当。
