Choo Seung Hwa, Lim Yong Su, Cho Jin Seong, Jang Jae Ho, Choi Jea Yeon, Choi Woo Sung, Yang Hyuk Jun
Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea.
Department of Emergency Medicine, Gachon University College of Medicine, Incheon, Korea.
Clin Exp Emerg Med. 2020 Sep;7(3):161-169. doi: 10.15441/ceem.19.075. Epub 2020 Sep 30.
No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED.
This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance.
This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667-0.791] vs. 0.681 [0.613-0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613-0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762-0.867) and 0.806 (0.754-0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00-1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02-1.11; P=0.002).
Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.
尚无研究评估缺血修饰白蛋白（IMA）对急诊科（ED）就诊患者脓毒症/脓毒性休克早期检测的诊断价值。我们旨在评估IMA在ED中诊断脓毒症/脓毒性休克的效用。
这项回顾性观察研究分析了ED就诊后1小时内测得的IMA、乳酸、高敏C反应蛋白和降钙素原水平。纳入至少符合两项全身炎症反应综合征标准的疑似感染患者，并使用Sepsis-3定义将其分为感染、脓毒症和脓毒性休克组。采用受试者工作特征曲线（AUC）下面积及95%置信区间（CI）和多因素逻辑回归来确定诊断性能。
本研究纳入了300例成年患者。IMA水平（截断值≥85.5 U/mL与≥87.5 U/mL）诊断脓毒症的AUC（95%CI）高于诊断脓毒性休克（0.729[0.667-0.791]对0.681[0.613-0.824]），且高于降钙素原水平（截断值≥1.58 ng/mL，0.678[0.613-0.742]）诊断脓毒症的AUC。当将IMA和乳酸水平联合时，诊断脓毒症和脓毒性休克的AUC分别为0.815（0.762-0.867）和0.806（0.754-0.858）。IMA水平可独立预测脓毒症（比值比，1.05；95%CI，1.00-1.09；P=0.029）和脓毒性休克（比值比，1.07；95%CI，1.02-1.11；P=0.002）。
我们的研究结果表明，IMA水平是早期诊断脓毒症/脓毒性休克的有用生物标志物，其与乳酸水平联合可增强在ED中早期诊断脓毒症/脓毒性休克的预测能力。
