Heart Institute (InCor), University of São Paulo Medical School, Brazil; GREAT (Global Research on Acute Conditions Team) Network.
Heart Institute (InCor), University of São Paulo Medical School, Brazil; GREAT (Global Research on Acute Conditions Team) Network; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland.
Int J Infect Dis. 2020 Jul;96:25-30. doi: 10.1016/j.ijid.2020.03.009. Epub 2020 Mar 10.
Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE.
Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis factor α (TNF-α), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality.
Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P<0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P=0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P=0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P=0.018), TNF-α (OR 1.8; 95%CI 1.1-2.9; P=0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P=0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-α 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-α 0.554, CRP 0.759).
S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE.
目前有关感染性心内膜炎（IE）患者风险预测生物标志物的证据有限。本研究旨在探讨一组生物标志物在预测 IE 患者住院死亡率中的价值。
2016 年至 2018 年间，前瞻性连续纳入急诊就诊的 IE 患者。在入院（D0）和抗生素治疗第 7 天（D7）时测定 9 种生物标志物的血浓度：C 反应蛋白（CRP）、敏感型肌钙蛋白 I（s-cTnI）、降钙素原、B 型利钠肽（BNP）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、白细胞介素 6（IL6）、肿瘤坏死因子-α（TNF-α）、前肾上腺髓质素、α-1-酸性糖蛋白和半乳糖凝集素 3。主要终点为住院死亡率。
97 例患者中，56%接受了心脏手术，住院死亡率为 27%。入院时，有 6 种生物标志物是住院死亡率的独立预测因子：s-cTnI（OR 3.4；95%CI 1.8-6.4；P<0.001）、BNP（OR 2.7；95%CI 1.4-5.1；P=0.002）、IL-6（OR 2.06；95%CI 1.3-3.7；P=0.019）、降钙素原（OR 1.9；95%CI 1.1-3.2；P=0.018）、TNF-α（OR 1.8；95%CI 1.1-2.9；P=0.019）和 CRP（OR 1.8；95%CI 1.0-3.3；P=0.037）。入院时，s-cTnI 对死亡率的预测准确性最高（ROC 曲线下面积：s-cTnI 0.812、BNP 0.727、IL-6 0.734、降钙素原 0.684、TNF-α 0.675、CRP 0.670）。在抗生素治疗 7 天后，BNP 和炎症生物标志物的性能有所提高（s-cTnI 0.814、BNP 0.823、IL-6 0.695、降钙素原 0.802、TNF-α 0.554、CRP 0.759）。
入院时测定的 s-cTnI 浓度对 IE 患者的死亡率预测具有最高的准确性。
