Guo Ying, Ren Manyi, Ge Lili, Sun Chao, Li Rui, Ma Cheng'en, Sui Shujian
Department of Intensive Care Unit, The Second Hospital of Shandong University, Jinan 250033, China.
Department of Cardiology, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014, China.
Emerg Med Int. 2019 Jan 10;2019:7238705. doi: 10.1155/2019/7238705. eCollection 2019.
We performed the current study to explore potential predictive value of serum Tumor Necrosis Factor- (TNF-) like weak inducer of apoptosis (TWEAK) concentrations for 28-day mortality in patients with sepsis. Adult septic patients (age≥18 years) admitted to a general ICU between November 2016 and October 2017 were consecutively included in our prospective observational study. TWEAK concentrations were detected in septic patients and healthy controls. Dynamic changes of TWEAK concentrations between 1st day and 3rd day of admission to ICU (ΔTWEAK concentrations) were also measured. A total of 79 septic patients were included and 19 of them (24.1%) died after a follow-up period of 28 days. We identified arterial lactate, NT-proBNP, and male gender as independent factors for 28-day mortality of patients with sepsis. The serum levels of TWEAK were significantly lower in septic patients compared to controls (417.4 ± 196.7 pg/ml versus 1243.8 ± 174.3 pg/ml, <0.001). We found a positive correlation between TWEAK concentrations and SOFA score (Spearman correlation coefficient 0.235, =0.037). Area under the receiver operating characteristic curve (AUROC) of ΔTWEAK concentrations for 28-day mortality was 0.754 (95% CI 0.645-0.844). We also evaluated the diagnostic performance of combinative index (ΔTWEAK concentrations and lactate) and obtained an AUROC of 0.860 (95% CI 0.763-0.928). In conclusion, our study found lower TWEAK concentrations in septic patients than those in healthy controls. Furthermore, the increased TWEAK concentrations during disease process predict higher 28-day mortality in septic patients. Dynamic changes of TWEAK should be an important supplement for current prognostic markers.
我们开展了本研究，以探讨血清肿瘤坏死因子样凋亡微弱诱导剂（TWEAK）浓度对脓毒症患者28天死亡率的潜在预测价值。2016年11月至2017年10月期间入住综合重症监护病房（ICU）的成年脓毒症患者（年龄≥18岁）连续纳入我们的前瞻性观察性研究。检测脓毒症患者和健康对照者的TWEAK浓度。还测量了入住ICU第1天至第3天TWEAK浓度的动态变化（ΔTWEAK浓度）。共纳入79例脓毒症患者，其中19例（24.1%）在28天随访期后死亡。我们确定动脉血乳酸、N末端脑钠肽前体（NT-proBNP）和男性性别为脓毒症患者28天死亡率的独立因素。与对照组相比，脓毒症患者的血清TWEAK水平显著降低（417.4±196.7 pg/ml对1243.8±174.3 pg/ml，P<0.001）。我们发现TWEAK浓度与序贯器官衰竭评估（SOFA）评分呈正相关（Spearman相关系数0.235，P=0.037）。ΔTWEAK浓度对28天死亡率的受试者工作特征曲线下面积（AUROC）为0.754（95%置信区间0.645-0.844）。我们还评估了联合指标（ΔTWEAK浓度和乳酸）的诊断性能，获得的AUROC为0.860（95%置信区间0.763-0.928）。总之，我们的研究发现脓毒症患者的TWEAK浓度低于健康对照者。此外，疾病过程中TWEAK浓度升高预示脓毒症患者28天死亡率更高。TWEAK的动态变化应是当前预后标志物的重要补充。
