一种新型分子宿主反应检测方法在高危胃肠手术后感染诊断中的初步研究。

A pilot study of a novel molecular host response assay to diagnose infection in patients after high-risk gastro-intestinal surgery.

机构信息

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.

出版信息

J Crit Care. 2019 Dec;54:83-87. doi: 10.1016/j.jcrc.2019.07.020. Epub 2019 Jul 30.

DOI:10.1016/j.jcrc.2019.07.020

PMID:31398685

Abstract

PURPOSE

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.

MATERIALS AND METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

目的

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。

材料与方法

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。

结果

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）。