Julius Center for health sciences and primary care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Julius Center for health sciences and primary care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands.
J Crit Care. 2019 Dec;54:83-87. doi: 10.1016/j.jcrc.2019.07.020. Epub 2019 Jul 30.
SeptiCyte LAB measures the expression of four host-response RNAs in peripheral blood to distinguish sepsis from sterile inflammation. This study evaluates whether sequential monitoring of this assay has diagnostic utility in patients after esophageal surgery.
Patients who developed a complication within 30 days following esophageal surgery and a random sample of 100 patients having an uncomplicated course. SeptiCyte LAB scores (ranging 0-10 reflecting increasing likelihood of infection) were compared to post-hoc physician adjudication of infection likelihood.
Among 370 esophagectomy patients, 120 (32%) subjects developed a complication requiring ICU (re)admission, 63 (53%) of whom could be analyzed. Immediate postoperative SeptiCyte LAB scores were highly variable, yet similar for patients having a complicated and uncomplicated postoperative course (median score of 2.4 (IQR 1.6-3.3) versus 2.2 (IQR 1.3-3), respectively). In a direct comparison of patients developing a confirmed infectious (n = 34) and non-infectious complication (n = 12), addition of SeptiCyte LAB to CRP improved diagnostic discrimination of infectious complications (AUC 0.88 (95%CI 0.77-0.99)) compared to CRP alone (AUC 0.76 (95%CI 0.61-0.91); p = .04).
Sequential measurement of SeptiCyte LAB may have diagnostic value in the monitoring of surgical patients at high risk of postoperative infection, but its clinical performance in this setting needs to be validated.
Sep- tiCyte LAB 通过检测外周血中四种宿主反应 RNA 的表达来区分脓毒症和无菌性炎症。本研究评估了该检测在食管手术后患者中连续监测的诊断效用。
选择术后 30 天内发生并发症的患者和 100 例无并发症患者作为随机样本。比较 Sep- tiCyte LAB 评分（范围 0-10，反映感染可能性增加）与术后医生判断的感染可能性。
在 370 例食管切除术患者中，120 例（32%）患者发生并发症需要 ICU（再次）入院，其中 63 例（53%）可进行分析。术后即刻 Sep- tiCyte LAB 评分差异较大，但术后并发症患者与无并发症患者相似（中位数评分分别为 2.4（IQR 1.6-3.3）和 2.2（IQR 1.3-3））。在比较发生确诊感染性（n=34）和非感染性并发症（n=12）的患者时，与单独使用 CRP 相比，添加 Sep- tiCyte LAB 可提高感染性并发症的诊断区分度（AUC 0.88（95%CI 0.77-0.99），而单独使用 CRP 的 AUC 为 0.76（95%CI 0.61-0.91）；p=0.04）。
在监测术后感染风险较高的外科患者时，连续测量 Sep- tiCyte LAB 可能具有诊断价值，但需要在该环境下验证其临床性能。
