Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n., La Laguna, Tenerife, Spain.
Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Crta Rosario s/n., Santa Cruz Tenerife, Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2021 Dec;39(10):493-497. doi: 10.1016/j.eimce.2020.08.007.
Scarce data on Fas, one of the main receptors that activates the apoptosis extrinsic pathway, in septic patients exists. Higher blood soluble Fas (sFas) concentrations in non-survivor septic patients compared with survivors have been found in small studies; however, the association of blood sFas concentrations with mortality controlling for sepsis severity has not been stablished due to this small sample size in those studies. Thus, our main objective study was to determine whether an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists.
We included septic patients in this observational and prospective study carried out in three Spanish Intensive Care Units. We obtained serum samples at sepsis diagnosis sepsis for sFas levels determination.
Thirty-day non-surviving patients (n=85) compared to surviving patients (n=151) had higher serum sFas levels (p<0.001). We found in multiple logistic regression analysis an association of serum sFas levels with mortality controlling for age and SOFA (OR=1.004; 95% CI=1.002-1.006; p<0.001), and for age and APACHE-II (OR=1.004; 95% CI=1.002-1.006; p<0.001). Serum sFas levels showed and area under the curve for mortality prediction of 71% (95% CI=65-71%; p<0.001). Kaplan-Meier analysis showed higher mortality rate in patients with serum sFas levels>83.5ng/mL (Hazard ratio=3.2; 95% CI=2.1-5.0; p<0.001).
That an association between blood sFas concentrations and sepsis mortality controlling for sepsis severity exists was our main new finding study.
在脓毒症患者中，关于 Fas 的数据很少，Fas 是激活细胞外凋亡途径的主要受体之一。在一些小型研究中发现，与幸存者相比，非幸存者脓毒症患者的血液可溶性 Fas（sFas）浓度更高；然而，由于这些研究的样本量较小，尚未确定血液 sFas 浓度与死亡率的关联是否与脓毒症严重程度有关。因此，我们的主要研究目的是确定血液 sFas 浓度与脓毒症死亡率之间是否存在关联，同时控制脓毒症的严重程度。
我们在西班牙的三个重症监护病房进行了这项观察性和前瞻性研究，纳入了脓毒症患者。在诊断为脓毒症时，我们获得了血清样本以确定 sFas 水平。
与存活患者（n=151）相比，30 天内未存活患者（n=85）的血清 sFas 水平更高（p<0.001）。我们在多变量逻辑回归分析中发现，血清 sFas 水平与死亡率之间存在关联，可控制年龄和 SOFA（OR=1.004；95%CI=1.002-1.006；p<0.001），以及年龄和 APACHE-II（OR=1.004；95%CI=1.002-1.006；p<0.001）。血清 sFas 水平对死亡率的预测具有 71%的曲线下面积（95%CI=65-71%；p<0.001）。Kaplan-Meier 分析显示，血清 sFas 水平>83.5ng/mL 的患者死亡率更高（危险比=3.2；95%CI=2.1-5.0；p<0.001）。
本研究的主要新发现是，在控制脓毒症严重程度的情况下，血液 sFas 浓度与脓毒症死亡率之间存在关联。
