The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC.
Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC.
Shock. 2021 Aug 1;56(2):237-244. doi: 10.1097/SHK.0000000000001709.
The aim of this study is to evaluate the association between burn injury and admission plasma levels of Syndecan-1 (SDC-1) and Tissue Factor Pathway Inhibitor (TFPI), and their ability to predict 30-day mortality.
SDC-1 and TFPI are expressed by vascular endothelium and shed into the plasma as biomarkers of endothelial damage. Admission plasma biomarker levels have been associated with morbidity and mortality in trauma patients, but this has not been well characterized in burn patients.Methods: This cohort study enrolled burn patients admitted to a regional burn center between 2013 and 2017. Blood samples were collected within 4 h of admission and plasma SDC-1 and TFPI were quantified by ELISA. Demographics and injury characteristics were collected prospectively. The primary outcome was 30-day in-hospital mortality.
Of 158 patients, 74 met inclusion criteria. Most patients were male with median age of 41.5 years and burn TBSA of 20.5%. The overall mortality rate was 20.3%. Admission SDC-1 and TFPI were significantly higher among deceased patients. Plasma SDC-1 >34 ng/mL was associated with a 32-times higher likelihood of mortality [OR: 32.65 (95% CI, 2.67-399.78); P = 0.006] and a strong predictor of mortality (area under the ROC [AUROC] 0.92). TFPI was associated with a nine-times higher likelihood of mortality [OR: 9.59 (95% CI, 1.02-89.75); P = 0.002] and a fair predictor of mortality (AUROC 0.68).
SDC-1 and TFPI are associated with a higher risk of 30-day mortality. We propose the measurement of SDC-1 on admission to identify burn patients at high risk of mortality. However, further investigation with a larger sample size is warranted.
本研究旨在评估烧伤患者入院时血浆中 syndecan-1（SDC-1）和组织因子途径抑制剂（TFPI）的水平与 30 天死亡率之间的关系，并评估其预测 30 天死亡率的能力。
SDC-1 和 TFPI 由血管内皮细胞表达，并作为内皮细胞损伤的生物标志物释放入血浆中。创伤患者入院时的生物标志物水平与发病率和死亡率有关，但在烧伤患者中尚未得到很好的描述。
这项队列研究纳入了 2013 年至 2017 年间在一个区域性烧伤中心就诊的烧伤患者。在入院后 4 小时内采集血样，并通过 ELISA 定量测定血浆 SDC-1 和 TFPI。前瞻性收集人口统计学和损伤特征。主要结局为 30 天院内死亡率。
在 158 例患者中，有 74 例符合纳入标准。大多数患者为男性，中位年龄为 41.5 岁，烧伤 TBSA 为 20.5%。总死亡率为 20.3%。死亡患者的入院 SDC-1 和 TFPI 明显升高。血浆 SDC-1＞34ng/ml 与死亡率增加 32 倍相关[比值比（OR）：32.65（95%可信区间，2.67-399.78）；P=0.006]，是死亡率的强预测指标（ROC 曲线下面积（AUROC）0.92）。TFPI 与死亡率增加 9 倍相关[比值比（OR）：9.59（95%可信区间，1.02-89.75）；P=0.002]，是死亡率的中等预测指标（AUROC 0.68）。
SDC-1 和 TFPI 与 30 天死亡率增加相关。我们建议在入院时测量 SDC-1，以识别高死亡率的烧伤患者。然而，需要进一步进行更大样本量的研究。
