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降钙素原和可溶性 CD14 亚型水平作为心脏手术患者术后不良并发症和死亡率的标志物。

Presepsin and Procalcitonin Levels as Markers of Adverse Postoperative Complications and Mortality in Cardiac Surgery Patients.

机构信息

IRRIV - International Renal Research Institute Vicenza, Vicenza, Italy.

Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, Acireale, Italy.

出版信息

Blood Purif. 2019;47(1-3):140-148. doi: 10.1159/000494207. Epub 2018 Oct 18.

Abstract

UNLABELLED

Backgound: This study was aimed at evaluating the presepsin and procalcitonin levels to predict adverse postoperative complications and mortality in cardiac surgery patients.

METHODS

A total of 122 cardiac surgery patients were enrolled for the study. Presepsin and procalcitonin levels were measured 48 h after the procedure. The primary endpoints were adverse renal, respiratory, and cardiovascular outcomes and mortality.

RESULTS

Presepsin and procalcitonin levels were significantly higher in patients with adverse renal and respiratory outcome (p < 0.001 and 0.0081). The presepsin levels were significantly higher in patients with adverse cardiovascular outcome (p = 0.023) and the procalcitonin values in patients with sepsis (p = 0.0013). Presepsin levels were significantly higher in patients who died during hospitalization (382 pg/mL, interquartile range [IQR] 243-717.5 vs. 1,848 pg/mL, IQR 998-5,451.5, p = 0.049). In addition, the predictive value for in-hospital, 30-days, and 6-months mortality was higher for presepsin, with a significant difference between the 2 biomarkers (p = 0.025, p = 0.035, p = 0.003; respectively). Presepsin and procalcitonin seem to have comparable predictive value for adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Although a positive trend was notable for presepsin and adverse renal outcome (area under the ROC [receiver operating characteristic] curves [AUC] of 0.760, 95% CI 0.673-0.833 versus procalcitonin: AUC 0.692; 95% CI 0.601-0.773): no statistically significant difference was evident between the AUC of the 2 biomarkers (p = 0.25).

CONCLUSIONS

Presepsin and -procalcitonin seem to have comparable predictive value for -adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Also, presepsin possesses a better predictive value for in-hospital, 30-days, and 6-months mortality.

摘要

背景

本研究旨在评估降钙素原和促炎因子前蛋白(PSEP)水平对心脏手术患者术后不良并发症和死亡率的预测价值。

方法

共纳入 122 例心脏手术患者。术后 48 小时测量降钙素原和 PSEP 水平。主要终点为不良肾功能、呼吸和心血管结局以及死亡率。

结果

与不良肾功能和呼吸结局患者相比,降钙素原和 PSEP 水平显著升高(p < 0.001 和 0.0081)。与心血管不良结局患者相比,PSEP 水平显著升高(p = 0.023),与脓毒症患者相比,降钙素原值显著升高(p = 0.0013)。住院期间死亡患者的 PSEP 水平显著升高(382pg/ml,四分位距 [IQR] 243-717.5 比 1848pg/ml,IQR 998-5451.5,p = 0.049)。此外,PSEP 的住院期间、30 天和 6 个月死亡率预测值均高于降钙素原,两种生物标志物之间存在显著差异(p = 0.025、p = 0.035、p = 0.003)。PSEP 和降钙素原似乎对心脏手术患者的不良肾功能、心血管和呼吸结局具有相当的预测价值。尽管 PSEP 与不良肾功能结局呈正相关趋势(ROC 曲线下面积 [AUC] 0.760,95%CI 0.673-0.833 与降钙素原相比:AUC 0.692;95%CI 0.601-0.773):但两种生物标志物的 AUC 之间无统计学差异(p = 0.25)。

结论

PSEP 和降钙素原似乎对心脏手术患者的不良肾功能、心血管和呼吸结局具有相当的预测价值。此外,PSEP 对住院期间、30 天和 6 个月的死亡率具有更好的预测价值。

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