Kulabukhov V V, Kudryavtsev A N, Kleuzovich A A, Chizhov A G, Raevskaya M B
Vishnevsky Institute of Surgery of Healthcare Ministry of the Russian Federation, Moscow, Russia.
Khirurgiia (Mosk). 2018(5):58-66. doi: 10.17116/hirurgia2018558-66.
To compare diagnostic value of molecular biomarkers of sepsis in patients with surgical infection in screening via Sepsis-2 (Surviving Sepsis Campaign 2012, SSC 2012) and Sepsis-3 (The Third International Consensus Definitions for Sepsis and Septic Shock) criteria.
Septic patients according to Sepsis-2 and Sepsis-3 criteria were identified from general population with surgical infection. Logistic regression models quality was the criterion for assessment of diagnostic value of molecular biomarkers. Risk factors importance was estimated via odds ratios (OR) calculation.
Sepsis-3 ROC-AUC for procalcitonin increased up to 0.933, cut-off value 2.35 ng/ml (Sepsis-2 AUC 0.768 (p=0.004), cut-off 1.72 ng/ml). Sepsis-3 ROC-AUC for presepsin increased up to 0.932, cut-off value - 772 pg/ml (Sepsis-2 AUC 0.865, cut-off 567 pg/ml). The highest risk of sepsis was observed in systemic response to inflammation combined with organ dysfunction (OR 69.667, S 0.636; 95% CI 20.03-242.4) (Sepsis-2 - OR 9.25, S 0.548; 95% CI 3.2-27.1, p<0.001). Increased levels of both biomarkers significantly increased the risk of sepsis (OR 22.5, S 0.794; 95% CI 4.74-106.6 and OR 20.97, S 0.58; 95% CI 6.705-65.6, respectively).
Organ dysfunction assessment by Sepsis-3 criteria improves diagnostic possibilities in patients with suspected sepsis. Maximum predictive value is observed for systemic inflammation response combined with organ dysfunction. In these patients procalcitonin and presepsin are characterized by equivalent high diagnostic potential for evidence of infectious nature of the disease. Increased level of these markers can serve as a basis for antimicrobial therapy administration.
比较脓毒症分子生物标志物在通过脓毒症-2（《拯救脓毒症运动2012》，SSC 2012）和脓毒症-3（《脓毒症和脓毒性休克第三次国际共识定义》）标准筛查的手术感染患者中的诊断价值。
从患有手术感染的普通人群中识别出符合脓毒症-2和脓毒症-3标准的脓毒症患者。逻辑回归模型质量是评估分子生物标志物诊断价值的标准。通过计算比值比（OR）来估计危险因素的重要性。
脓毒症-3中降钙素原的ROC-AUC增加至0.933，临界值为2.35 ng/ml（脓毒症-2的AUC为0.768（p = 0.004），临界值为1.72 ng/ml）。脓毒症-3中可溶性髓系细胞触发受体-1的ROC-AUC增加至0.932，临界值为-772 pg/ml（脓毒症-2的AUC为0.865，临界值为567 pg/ml）。在全身炎症反应合并器官功能障碍时观察到最高的脓毒症风险（OR 69.667，S 0.636；95% CI 20.03 - 242.4）（脓毒症-2 - OR 9.25，S 0.548；95% CI 3.2 - 27.1，p < 0.001）。两种生物标志物水平升高均显著增加脓毒症风险（分别为OR 22.5，S 0.794；95% CI 4.74 - 106.6和OR 20.97，S 0.58；95% CI 6.705 - 65.6）。
采用脓毒症-3标准评估器官功能障碍可提高疑似脓毒症患者的诊断可能性。全身炎症反应合并器官功能障碍时观察到最大预测价值。在这些患者中，降钙素原和可溶性髓系细胞触发受体-1在证明疾病感染性质方面具有同等高的诊断潜力。这些标志物水平升高可作为给予抗菌治疗的依据。
