Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris, Paris Diderot University, Paris, France.
Biostatistics Department, Saint-Louis Hospital, Paris Diderot University, Paris, France.
Crit Care Med. 2018 Mar;46(3):e250-e257. doi: 10.1097/CCM.0000000000002934.
To assess whether serum concentration of endothelial cell-specific molecule-1 (Endocan) at ICU admission is associated with the use of ICU resources and outcomes in critically ill hematology patients.
Prospective multicenter cohort study.
Seventeen ICUs in France and Belgium.
Seven hundred forty-four consecutive critically ill hematology patients; 72 critically ill septic patients without hematologic malignancy; 276 healthy subjects.
None.
Median total endocan concentrations were 4.46 (2.7-7.8) ng/mL. Endocan concentrations were higher in patients who had received chemotherapy before ICU admission (4.7 [2.8-8.1] ng/mL vs. 3.7 [2.5-6.3] ng/mL [p = 0.002]). In patients with acute respiratory failure, endocan levels were increased in patients with drug-induced pulmonary toxicity compared with other etiologies (p = 0.038). Total endocan levels higher than 4.46 ng/mL were associated with a higher cumulative probability of renal replacement therapy requirement (p = 0.006), a higher requirement of mechanical ventilation (p = 0.01) and a higher requirement of vasopressors throughout ICU stay (p < 0.0001). By multivariate analysis, total endocan levels at admission were independently associated with ICU mortality (odds ratios, 1.39; 95% CI, 1.06-1.83; p = 0.018). The predictive value of endocan peptide fragments of 14 kDa in terms of mortality and life-sustaining therapies requirement was inferior to that of total endocan. Endocan levels were higher in critically ill hematology patients compared with healthy subjects (p < 0.0001) but lower than endocan values in critically ill septic patients without hematologic malignancy (p = 0.005) CONCLUSIONS:: Serum concentrations of endocan at admission are associated with the use of ICU resources and mortality in critically ill hematology patients. Studies to risk-stratify patients in the emergency department or in the hematology wards based on endocan concentrations to identify those likely to benefit from early ICU management are warranted.
评估 ICU 入院时内皮细胞特异性分子-1（Endocan）的血清浓度与危重病血液病患者 ICU 资源利用和结局的关系。
前瞻性多中心队列研究。
法国和比利时的 17 个 ICU。
744 例连续危重病血液病患者；72 例无血液恶性肿瘤的危重病脓毒症患者；276 例健康受试者。
无。
中位总内克浓度为 4.46（2.7-7.8）ng/ml。接受 ICU 入院前化疗的患者内克浓度较高（4.7 [2.8-8.1] ng/ml 与 3.7 [2.5-6.3] ng/ml [p=0.002]）。在急性呼吸衰竭患者中，与其他病因相比，药物性肺毒性患者的内克水平升高（p=0.038）。总内克水平高于 4.46 ng/ml 与更高的累积概率需要肾脏替代治疗（p=0.006）、需要机械通气（p=0.01）和整个 ICU 期间需要血管加压药（p<0.0001）相关。多变量分析显示，入院时总内克水平与 ICU 死亡率独立相关（优势比，1.39；95%CI，1.06-1.83；p=0.018）。14 kDa 内克肽片段在死亡率和维持生命治疗需求方面的预测价值低于总内克。与健康受试者相比，危重病血液病患者的内克水平较高（p<0.0001），但低于无血液恶性肿瘤的危重病脓毒症患者的内克值（p=0.005）。
入院时内克的血清浓度与危重病血液病患者的 ICU 资源利用和死亡率相关。有必要基于内克浓度在急诊科或血液科病房对患者进行风险分层，以确定那些可能受益于早期 ICU 管理的患者。
