S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy.
Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
Sci Rep. 2020 Feb 20;10(1):3103. doi: 10.1038/s41598-020-59884-6.
Acute aortic syndromes (AASs) are difficult to diagnose emergencies. Plasma soluble ST2 (sST2), a prognostic biomarker for heart failure, has been proposed as a diagnostic biomarker of AASs outperforming D-dimer, the current diagnostic standard. We performed a prospective diagnostic accuracy study of sST2 for AASs in the Emergency Department (ED). In 2017-2018, patients were enrolled if they had ≥1 red-flag symptoms (chest/abdominal/back pain, syncope, perfusion deficit) and a clinical suspicion of AAS. sST2 was detected with the Presage® assay. Adjudication was based on computed tomography angiography (CTA) or on diagnostic outcome inclusive of 30-day follow-up. 297 patients were enrolled, including 88 with AASs. The median age was 67 years. In 162 patients with CTA, the median sST2 level was 41.7 ng/mL (IQR 29.4-103.2) in AASs and 34.6 ng/mL (IQR 21.4-51.5) in alternative diagnoses (P = 0.005). In ROC analysis, the AUC of sST2 was 0.63, as compared to 0.82 of D-dimer (P < 0.001). Sensitivity and specificity values of sST2 associated with different cutoffs were: 95.5% and 10.8% (≥12 ng/mL), 84.1% and 29.7% (≥23.7 ng/mL), 35.2% and 85.1% (≥66.5 ng/mL). Results were similar in the full cohort. In conclusion, in patients from a European ED, plasma sST2 provided modest accuracy for diagnosis of AASs.
急性主动脉综合征（AAS）是一种难以诊断的急症。血浆可溶性 ST2（sST2）作为心力衰竭的预后生物标志物，已被提出作为优于当前诊断标准的 D-二聚体的 AAS 诊断生物标志物。我们在急诊科（ED）进行了 sST2 对 AAS 的前瞻性诊断准确性研究。在 2017-2018 年，如果患者有≥1 个红色标志症状（胸痛/腹痛/背痛、晕厥、灌注不足）和 AAS 的临床怀疑，则纳入研究。sST2 用 Presage® assay 检测。裁决基于计算机断层血管造影（CTA）或包括 30 天随访的诊断结果。共纳入 297 例患者，其中 88 例为 AAS。中位年龄为 67 岁。在 162 例行 CTA 的患者中，AAS 患者的中位 sST2 水平为 41.7ng/mL（IQR 29.4-103.2），替代诊断为 34.6ng/mL（IQR 21.4-51.5）（P=0.005）。在 ROC 分析中，sST2 的 AUC 为 0.63，而 D-二聚体为 0.82（P<0.001）。与不同截断值相关的 sST2 的敏感性和特异性值分别为：95.5%和 10.8%（≥12ng/mL）、84.1%和 29.7%（≥23.7ng/mL）、35.2%和 85.1%（≥66.5ng/mL）。在全队列中结果相似。总之，在来自欧洲 ED 的患者中，血浆 sST2 对 AAS 的诊断准确性中等。
