Department of Critical Care Medicine, Xiangya Hospital of Centre-south University, Changsha, 410008, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, PR China.
Sci Rep. 2020 May 7;10(1):7718. doi: 10.1038/s41598-020-64200-3.
We investigated the role of dynamic changes of serum levels S100B protein in brain injury and poor outcome of sepsis. This is a prospective cohort study designed to include 104 adult patients with sepsis who are admitted to ICU from Jan 2015 to Aug 2016. Sepsis was defined as sepsis 3.0. Patients with a GCS score of <15, or at least one positive CAM-ICU score were thought to have brain dysfunction. 59 patients were diagnosed with SAE and the rest 45 patients were diagnosed with non-SAE. Serum S100B was measured on day 1 and 3 after ICU admission. Primary outcomes included brain dysfunction and 28-day/180-day mortality. The SAE group showed a significantly higher APACHE II score, SOFA scores, length of ICU stay, 28-day and 180-day mortality, serum S100B levels on day 1 and day 3. S100B levels on day 1 of 0.226 μg/L were diagnostic for SAE with 80.0% specificity and 66.1% sensitivity, and the area under (AUC) the curve was 0.728, S100B levels on day 3 of 0.144 μg/L were diagnostic for SAE with 84.44% specificity and 69.49% sensitivity, and the AUC was 0.819. In addition, the AUC for S100B on day 3 for predicting 180-day mortality was larger than for S100B on day 1 (0.731 vs. 0.611). Multiple logistic regression analysis showed that S100B3 (p = 0.001) but not S100B1 (p = 0.927) were independently correlated with SAE. Kaplan-Meier survival analysis showed that patients with S100B levels higher than 0.144 μg/L had a lower probability of survival at day 180. There were more patients with encephalopathy and a higher 28-day or 180-day mortality in the ΔS100B + group than in the ΔS100B- group. Multiple logistic regression analysis showed that SAE and IL-6 on day 3 were independently correlated with S100B dynamic increase. These findings suggest that elevated serum S100B levels on day 3 and the dynamic changes of serum S100B levels from day three to one were more associated with brain dysfunction and mortality than that on day 1 in patients with sepsis.
我们研究了血清 S100B 蛋白水平的动态变化在脓毒症脑损伤和预后不良中的作用。这是一项前瞻性队列研究，纳入了 2015 年 1 月至 2016 年 8 月入住 ICU 的 104 例成人脓毒症患者。脓毒症定义为脓毒症 3.0。格拉斯哥昏迷评分（GCS）<15 分或至少有一个阳性 CAM-ICU 评分的患者被认为存在脑功能障碍。59 例患者被诊断为 SAE，其余 45 例患者被诊断为非 SAE。入院后第 1 天和第 3 天检测血清 S100B。主要结局包括脑功能障碍和 28 天/180 天死亡率。SAE 组的急性生理与慢性健康状况评分系统 II（APACHE II）评分、序贯器官衰竭评估（SOFA）评分、ICU 住院时间、28 天和 180 天死亡率以及第 1 天和第 3 天的血清 S100B 水平均显著升高。第 1 天血清 S100B 水平为 0.226μg/L 时诊断 SAE 的特异性为 80.0%，敏感性为 66.1%，曲线下面积（AUC）为 0.728；第 3 天血清 S100B 水平为 0.144μg/L 时诊断 SAE 的特异性为 84.44%，敏感性为 69.49%，AUC 为 0.819。此外，第 3 天 S100B 预测 180 天死亡率的 AUC 大于第 1 天（0.731 vs. 0.611）。多因素 logistic 回归分析显示，S100B3（p=0.001）而非 S100B1（p=0.927）与 SAE 独立相关。Kaplan-Meier 生存分析显示，血清 S100B 水平高于 0.144μg/L 的患者在第 180 天的生存率较低。ΔS100B+组患者中脑病和 28 天或 180 天死亡率较高的患者比例高于ΔS100B-组。多因素 logistic 回归分析显示，第 3 天的 SAE 和白细胞介素 6（IL-6）与 S100B 动态增加独立相关。这些发现表明，与第 1 天相比，脓毒症患者第 3 天血清 S100B 水平升高以及第 3 天至第 1 天血清 S100B 水平的动态变化与脑功能障碍和死亡率的相关性更强。
