Hu Chenggong, Zhou Yongfang, Liu Chang, Kang Yan
Department of Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, Nanchong, China.
Oncotarget. 2017 Dec 26;9(4):5125-5136. doi: 10.18632/oncotarget.23701. eCollection 2018 Jan 12.
The purpose of this study was to confirm the prognostic value of pentraxin-3 (PTX3), procalcitonin (PCT) and lactate in patients with severe infections requiring ICU management and to develop and validate a model to enhance mortality prediction by combining severity scores with biomarkers. We included 141 patients with the diagnosis of sepsis/septic shock. The levels of PTX3, PCT and lactate were measured on day 0, 3, 7 of hospitalization and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were also evaluated. The influence of these variables on 28-day mortality was evaluated. The 28-day mortality rate in this study was 28.8%. The baseline levels of PTX3, PCT and lactate in the non-survival group were higher than in the survival group (P < 0.05 for all). Pearson's correlation found that PTX3, PCT and lactate were all positively correlated with SOFA and APACHE II scores (P <0.01 for all). Univariate and multivariate Cox regression revealed that PTX3, PCT and lactate were independently associated with 28-day mortality. The models combining above three biomarkers performed better predictive property than each individual one as determined by receiver operating characteristic (ROC) analysis. In summary, our results suggest that PTX3, PCT and lactate could serve as clinically informative biomarkers of disease severity and patient outcome in sepsis/septic shock. A model combining PTX3, PCT and lactate improves mortality prediction in these patients.
本研究的目的是证实五聚体-3（PTX3）、降钙素原（PCT）和乳酸对需要重症监护病房（ICU）管理的严重感染患者的预后价值，并开发和验证一个通过将严重程度评分与生物标志物相结合来提高死亡率预测的模型。我们纳入了141例诊断为脓毒症/脓毒性休克的患者。在住院第0天、第3天和第7天测量PTX3、PCT和乳酸水平，并评估序贯器官衰竭评估（SOFA）和急性生理与慢性健康状况评分系统II（APACHE II）评分。评估这些变量对28天死亡率的影响。本研究中的28天死亡率为28.8%。非存活组中PTX3、PCT和乳酸的基线水平高于存活组（所有P<0.05）。Pearson相关性分析发现，PTX3、PCT和乳酸均与SOFA和APACHE II评分呈正相关（所有P<0.01）。单因素和多因素Cox回归显示，PTX3、PCT和乳酸与28天死亡率独立相关。通过受试者工作特征（ROC）分析确定，结合上述三种生物标志物的模型比每个单独的生物标志物具有更好的预测性能。总之，我们的结果表明，PTX3、PCT和乳酸可作为脓毒症/脓毒性休克中疾病严重程度和患者预后的临床信息性生物标志物。结合PTX3、PCT和乳酸的模型可改善这些患者的死亡率预测。
