创伤后升高的 Syndecan-1 与脓毒症风险：来自实用、随机、优化血小板和血浆比例（PROPPR）试验的患者的二次分析。
Elevated Syndecan-1 after Trauma and Risk of Sepsis: A Secondary Analysis of Patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial.
机构信息
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX.
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX.
出版信息
J Am Coll Surg. 2018 Dec;227(6):587-595. doi: 10.1016/j.jamcollsurg.2018.09.003. Epub 2018 Sep 21.
BACKGROUND
Endotheliopathy of trauma is characterized by breakdown of the endothelial glycocalyx. Elevated biomarkers of endotheliopathy, such as serum syndecan-1 (Synd-1) ≥ 40 ng/mL, have been associated with increased need for transfusions, complications, and mortality. We hypothesized that severely injured trauma patients who exhibit elevated Synd-1 levels shortly after admission have an increased likelihood of developing sepsis.
STUDY DESIGN
We analyzed a subset of patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial who survived at least 72 hours after hospital admission, and we determined elevated Synd-1 levels (≥ 40 ng/mL) 4 hours after hospital arrival. Sepsis was defined a priori as meeting systemic inflammatory response criteria and having a known or suspected infection. Univariate analysis was performed to identify variables associated with elevated Synd-1 levels and sepsis. Significant variables at a value of p < 0.2 in the univariate analysis were chosen by purposeful selection and analyzed in a mixed effects multivariate logistic regression model to account for the 12 different study sites.
RESULTS
We included 512 patients. Of these, 402 (79%) had elevated Synd-1 levels, and 180 (35%) developed sepsis. Median Synd-1 levels at 4 hours after admission were 70 ng/dL (interquartile range [IQR] 36 to 157 ng/dL) in patients who did not develop sepsis, and 165 ng/dL [IQR 67 to 336 ng/dL] in those who did (p < 0.001). Adjusting for treatment arm and site, multivariable analyses revealed that elevated Synd-1 status, Injury Severity Score (ISS), and total blood transfused were significantly associated with an increased likelihood of developing sepsis.
CONCLUSIONS
Elevated Synd-1 levels 4 hours after admission in severely injured adult trauma patients who survived the initial 72 hours after hospital admission are associated with subsequent sepsis.
背景
创伤性内皮病的特征是内皮糖萼的破裂。升高的内皮病生物标志物，如血清连接蛋白-1（Synd-1）≥40ng/mL，与输血需求增加、并发症和死亡率增加有关。我们假设，在入院后不久即表现出升高的 Synd-1 水平的严重创伤患者，发生脓毒症的可能性增加。
研究设计
我们分析了 Pragmatic，Randomized Optimal Platelet and Plasma Ratios（PROPPR）试验中的一部分患者，这些患者在入院后至少 72 小时存活，并且我们在入院后 4 小时确定了升高的 Synd-1 水平（≥40ng/mL）。脓毒症是指预先定义的符合全身炎症反应标准且存在已知或疑似感染的患者。进行单变量分析以确定与升高的 Synd-1 水平和脓毒症相关的变量。在单变量分析中 p 值<0.2 的显著变量通过有目的的选择选择，并在混合效应多变量逻辑回归模型中进行分析，以考虑到 12 个不同的研究地点。
结果
我们纳入了 512 名患者。其中，402 名（79%）患者的 Synd-1 水平升高，180 名（35%）患者发生脓毒症。在未发生脓毒症的患者中，入院后 4 小时的中位 Synd-1 水平为 70ng/dL（四分位距 [IQR]36 至 157ng/dL），而在发生脓毒症的患者中为 165ng/dL [IQR67 至 336ng/dL]（p<0.001）。调整治疗臂和地点后，多变量分析显示，升高的 Synd-1 状态、损伤严重程度评分（ISS）和总输血量与发生脓毒症的可能性增加显著相关。
结论
在入院后最初 72 小时存活的严重创伤成年患者中，入院后 4 小时升高的 Synd-1 水平与随后发生的脓毒症有关。
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