在诊断时丙酸的作用可预测脓毒性休克患者的死亡率。
The role of propionic acid at diagnosis predicts mortality in patients with septic shock.
机构信息
Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China.
Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China.
出版信息
J Crit Care. 2018 Feb;43:95-101. doi: 10.1016/j.jcrc.2017.08.009. Epub 2017 Aug 5.
PURPOSE
This study aims to assess the diagnostic and prognostic value of propionic acid in patients with septic shock on a medical intensive care unit (ICU).
METHODS
Serum propionic acid and clinical common cytokines levels were measured within 24h after the diagnosis of sepsis, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and Mortality were recorded in ICU. A 28-day and 90-day follow-up was performed for all patients.
RESULTS
A total of 118 septic patients were enrolled in this study. The propionic acid was higher in patients with septic shock compared with sepsis. Multivariate logistic regression analysis showed that propionic acid was independent predictor of sepsis (odds ratio: 1.279; 95% confidence interval: 1.069-1.530; P=0.007) and septic shock (odds ratio: 1.859; 95% confidence interval: 1.342-2.576; P<0.001) and ICU mortality (odds ratio: 1.331; 95% confidence interval: 1.107-1.600; P=0.002), 28-day mortality (odds ratio: 1.259; 95% confidence interval: 1.046-1.514; P=0.015) and 90-day mortality (odds ratio: 1.304; 95% confidence interval: 1.092-1.558; P=0.003). The receiver operating characteristic curve (AUC) analysis showed the areas under of propionic acid on ICU admission day for predicting sepsis and septic shock were 0.773 and 0.85 respectively, the areas under of propionic acid for predicting ICU mortality, 28-d and 90-d mortality were 0.779, 0.739 and 0.809 respectively. Using a PA cutoff of 0.053 and 0.095 for predicting sepsis and septic shock respectively, the sensitivity was 97.62% and 85.5%, and the specificity was 58% and 83.5%, respectively. Using a PA cutoff of 0.139 for predicting ICU mortality, 28- and 90-day mortality, the sensitivity was 69.39%, 67.44% and 69.09% respectively, and the specificity was 78.26%, 73.33% and 82.54% respectively.
CONCLUSIONS
Propionic acid showed diagnostic capacity to diagnose septic shock and revealed prognostic information for mortality.
目的
本研究旨在评估丙酸在脓毒性休克患者中的诊断和预后价值。
方法
在诊断脓毒症后 24 小时内测量血清丙酸和临床常见细胞因子水平，并记录重症监护病房（ICU）的急性生理学和慢性健康评估 II 评分（APACHE II 评分）、序贯器官衰竭评估（SOFA）评分和死亡率。对所有患者进行 28 天和 90 天的随访。
结果
本研究共纳入 118 例脓毒症患者。与脓毒症相比，脓毒性休克患者的丙酸水平更高。多变量逻辑回归分析表明，丙酸是脓毒症（比值比：1.279；95%置信区间：1.069-1.530；P=0.007）和脓毒性休克（比值比：1.859；95%置信区间：1.342-2.576；P<0.001）以及 ICU 死亡率（比值比：1.331；95%置信区间：1.107-1.600；P=0.002）、28 天死亡率（比值比：1.259；95%置信区间：1.046-1.514；P=0.015）和 90 天死亡率（比值比：1.304；95%置信区间：1.092-1.558；P=0.003）的独立预测因子。丙酸入院当天的受试者工作特征曲线（AUC）分析显示，预测脓毒症和脓毒性休克的 AUC 分别为 0.773 和 0.85，预测 ICU 死亡率、28 天和 90 天死亡率的 AUC 分别为 0.779、0.739 和 0.809。分别使用 PA 截断值 0.053 和 0.095 预测脓毒症和脓毒性休克，敏感度分别为 97.62%和 85.5%，特异度分别为 58%和 83.5%。使用 PA 截断值 0.139 预测 ICU 死亡率、28 天和 90 天死亡率，敏感度分别为 69.39%、67.44%和 69.09%，特异度分别为 78.26%、73.33%和 82.54%。
结论
丙酸具有诊断脓毒性休克的能力，并提供了死亡率的预后信息。
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