Hamed Sonja, Behnes Michael, Pauly Dominic, Lepiorz Dominic, Barre Max, Becher Tobias, Lang Siegfried, Akin Ibrahim, Borggrefe Martin, Bertsch Thomas, Hoffmann Ursula
Clin Lab. 2018 Jun 1;64(6):999-1011. doi: 10.7754/Clin.Lab.2018.180116.
The prognostic value of the acute phase protein Pentraxin 3 (PTX-3) is not well evaluated in patients with septic shock, which reveal an unacceptably high short- and long-term mortality. New Sepsis-3 definitions are not yet implemented in most biomarker studies. Therefore, this study assesses the prognostic value of PTX-3 for short- and mid-term mortality in patients with sepsis or septic shock, as defined by the latest definitions, treated at a medical intensive care unit (ICU).
The study includes 213 ICU patients with clinical criteria of sepsis and septic shock. Plasma levels of PTX-3, procalcitonin (PCT) and interleukin-6 were measured on day 1, 3, and 8. All-cause mortality was followed up to 30 days and at 6 months.
On all three days, PTX-3 levels were able to discriminate non-survivors from survivors at 30 days and 6 months (AUC range: 0.59 - 0.70; 95% CI: 0.52 - 0.79; p ≤ 0.02). Highest PTX-3 levels within the fourth quartiles during the first week of ICU treatment were associated with an increased mortality rate at 30 days (OR = 7; 95% CI: 2.0 - 23.5; p ≤ 0.002) and at 6 months (OR = 5; 95% CI: 2.1 - 11.4; p ≤ 0.006). Additionally, the prognostic value of PTX-3 was proven for all patients as well as in subcohorts of patients with sepsis and septic shock, according to Sepsis-3 criteria, both in univariate and multivariate analyses for 30-day and 6-months all-cause mortality, especially predicting all-cause mortality in septic shock (HRs range: 1.0 - 2.9; 95% CI: 0.3 - 5.1; p ≤ 0.03).
PTX-3 offers prognostic value for the prediction of short- and mid-term all-cause mortality in patients suffering from sepsis and septic shock according to the latest Sepsis-3 criteria.
急性期蛋白3型五聚体蛋白（PTX-3）在感染性休克患者中的预后价值尚未得到充分评估，这类患者的短期和长期死亡率高得令人难以接受。大多数生物标志物研究尚未采用新的脓毒症-3定义。因此，本研究评估了PTX-3对入住医疗重症监护病房（ICU）、符合最新定义的脓毒症或感染性休克患者短期和中期死亡率的预后价值。
该研究纳入了213例符合脓毒症和感染性休克临床标准的ICU患者。在第1天、第3天和第8天测量PTX-3、降钙素原（PCT）和白细胞介素-6的血浆水平。对全因死亡率进行随访，直至30天和6个月。
在所有这三天中，PTX-3水平能够区分30天和6个月时的非幸存者和幸存者（AUC范围：0.59 - 0.70；95%CI：0.52 - 0.79；p≤0.02）。ICU治疗第一周内四分位数最高的PTX-3水平与30天时（OR = 7；95%CI：2.0 - 23.5；p≤0.002）和6个月时（OR = 5；95%CI：2.1 - 11.4；p≤0.006）死亡率增加相关。此外，根据脓毒症-3标准，在单因素和多因素分析中，PTX-3对所有患者以及脓毒症和感染性休克患者亚组的30天和6个月全因死亡率的预后价值均得到证实，尤其是预测感染性休克中的全因死亡率（HR范围：1.0 - 2.9；95%CI：0.3 - 5.1；p≤0.03）。
根据最新的脓毒症-3标准，PTX-3对脓毒症和感染性休克患者短期和中期全因死亡率的预测具有预后价值。
