Wu Xiaoling, Hu Ke, Yu Li, Wang Hui, Long Ding
Department of Respiration Medicine, Renmin Hospital of Wuhan University Wuhan, China.
Intensive Care Unit, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology Wuhan, China.
Int J Clin Exp Pathol. 2017 Dec 1;10(12):11378-11383. eCollection 2017.
The aim of this study was to investigate the association of plasma suPAR expression with disease risk and severity as well as prognosis of sepsis-induced acute respiratory distress syndrome (ARDS). 162 ARDS patients were consecutively enrolled in this study and categorized into sepsis-induced ARDS group (N=104) or non-sepsis-induced ARDS group (N=58) according to the cause of ARDS. Disease severity was evaluated as mild, moderate and severe disease based on lowest PaO/FiO ratio. Acute Physiology and Chronic Health Evaluation (APACHE) II as well as Sequential Organ Failure Assessment (SOFA) scores were calculated. Serum procalcitonin (PCT) was detected by electro chemiluminescence immunoassay, and plasma suPAR was determined by enzyme-linked immunosorbent assay. Sepsis-induced ARDS presented with elevated plasma suPAR level (P<0.001), serum PCT level (P<0.001), APACHE II score (P<0.001) and SOFA score (P<0.001) compared with patients with non-sepsis-induced ARDS. Plasma suPAR level was positively correlated with disease severity (P<0.001), PCT level (P<0.001), APACHE II score (P<0.001) and SOFA score (P<0.001). Among 104 sepsis-induced ARDS patients, 73 cases survived (survival group) while other 31 cased dies (non-survival group). Plasma suPAR level was greatly increased in non-survival group compared to survival group (P<0.001). Furthermore, ROC curve analysis illustrated that suPAR level presented good diagnostic value in predicting mortality with AUC 0.81 (95% CI: 0.73-0.89). Plasma suPAR is increased in sepsis-induced ARDS patients, and it correlates with higher disease severity and unfavorable prognosis.
本研究旨在探讨血浆可溶性尿激酶型纤溶酶原激活物受体（suPAR）表达与脓毒症诱发的急性呼吸窘迫综合征（ARDS）的疾病风险、严重程度及预后之间的关联。本研究连续纳入了162例ARDS患者，并根据ARDS的病因将其分为脓毒症诱发的ARDS组（N = 104）和非脓毒症诱发的ARDS组（N = 58）。根据最低动脉血氧分压/吸入氧浓度（PaO/FiO）比值将疾病严重程度评估为轻度、中度和重度。计算急性生理与慢性健康状况评分系统（APACHE）II以及序贯器官衰竭评估（SOFA）评分。采用电化学发光免疫分析法检测血清降钙素原（PCT），采用酶联免疫吸附测定法测定血浆suPAR。与非脓毒症诱发的ARDS患者相比，脓毒症诱发的ARDS患者血浆suPAR水平升高（P < 0.001）、血清PCT水平升高（P < 0.001）、APACHE II评分升高（P < 0.001）以及SOFA评分升高（P < 0.001）。血浆suPAR水平与疾病严重程度（P < 0.001）、PCT水平（P < 0.001）、APACHE II评分（P < 0.001）以及SOFA评分（P < 0.001）呈正相关。在104例脓毒症诱发的ARDS患者中，73例存活（存活组），31例死亡（非存活组）。与存活组相比，非存活组血浆suPAR水平显著升高（P < 0.001）。此外，受试者工作特征（ROC）曲线分析表明，suPAR水平在预测死亡率方面具有良好的诊断价值，曲线下面积（AUC）为0.81（95%可信区间：0.73 - 0.89）。脓毒症诱发的ARDS患者血浆suPAR升高，且与更高的疾病严重程度及不良预后相关。
