Shimoyama Yuichiro, Umegaki Osamu, Kadono Noriko, Minami Toshiaki
Department of Anesthesiology, Osaka Medical College, Intensive Care Unit, Osaka Medical College Hospital, Takatsuki, Japan.
Department of Anesthesiology, Osaka Medical College, Osaka Medical College Hospital, Takatsuki, Japan.
Shock. 2021 Apr 1;55(4):501-506. doi: 10.1097/SHK.0000000000001664.
Sepsis remains a major cause of mortality in critically ill patients. This study aimed to determine whether presepsin is a predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and shock.
A total of 83 adult patients diagnosed with sepsis were prospectively examined. Presepsin values were measured immediately after intensive care unit (ICU) admission and on Days 2, 3, and 5 after ICU admission. Glasgow Prognostic Score (GPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, Prognostic Index, and Prognostic Nutritional Index were also examined at baseline. For category classification, total scores were calculated (hereafter, "inflammation-presepsin scores [iPS]") as follows: a score of 1 was assigned if the presepsin value and inflammation-based prognostic scores at baseline were above cutoffs determined by receiver operating characteristic (ROC) curve analysis for 28-day mortality; a score of 0 was assigned if they were below the cutoffs (total score range, 0-2 points). Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with septic AKI, ARDS, DIC, or shock and those without these disorders.
ROC curve analyses identified the following variables as predictors: presepsin on Days 1 and 2 for septic AKI; presepsin on Days 1 to 3; and iPS-GPS for septic ARDS; and presepsin on Day 2 and Δpresepsin (Day 2-Day 1) for septic DIC. Multivariate analysis revealed presepsin on Day 2 to be a predictor of septic DIC.
Presepsin is a predictor of septic AKI, ARDS, and DIC. Combining presepsin values with GPS improved the specificity for predicting septic ARDS relative to using baseline presepsin values alone.
脓毒症仍然是危重症患者死亡的主要原因。本研究旨在确定可溶性髓系细胞触发受体-1（presepsin）是否为脓毒症急性肾损伤（AKI）、急性呼吸窘迫综合征（ARDS）、弥散性血管内凝血（DIC）和休克的预测指标。
对83例诊断为脓毒症的成年患者进行前瞻性检查。在重症监护病房（ICU）入院后即刻以及入院后第2、3和5天测量presepsin值。在基线时还检查了格拉斯哥预后评分（GPS）、中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值、预后指数和预后营养指数。对于类别分类，计算总分（以下简称“炎症-presepsin评分[iPS]”）如下：如果基线时presepsin值和基于炎症的预后评分高于通过28天死亡率的受试者工作特征（ROC）曲线分析确定的临界值，则给予1分；如果低于临界值，则给予0分（总分范围为0-2分）。比较脓毒症AKI、ARDS、DIC或休克患者与无这些疾病患者的presepsin值、基于炎症的预后评分和iPS。
ROC曲线分析确定了以下变量为预测指标：脓毒症AKI第1天和第2天的presepsin；第1至3天的presepsin；脓毒症ARDS的iPS-GPS；脓毒症DIC第2天的presepsin和Δpresepsin（第2天-第1天）。多因素分析显示第2天的presepsin是脓毒症DIC的预测指标。
Presepsin是脓毒症AKI、ARDS和DIC的预测指标。相对于单独使用基线presepsin值，将presepsin值与GPS相结合提高了预测脓毒症ARDS的特异性。
