Xu Yunyu, Li Nanyang, Gao Jiamin, Shang Da, Zhang Min, Mao Xiaoyi, Chen Ruiying, Zheng Jianming, Shan Ying, Chen Mingquan, Xie Qionghong, Hao Chuan-Ming
Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.
Department of Emergency, Huashan Hospital, Fudan University, Shanghai, China.
Front Med (Lausanne). 2021 Nov 26;8:759273. doi: 10.3389/fmed.2021.759273. eCollection 2021.
Multiple organ dysfunction is a complex and lethal clinical feature with heterogeneous causes and is usually characterized by tissue injury of multiple organs. Tenascin-C (TNC) is a matricellular protein that is rarely expressed in most of the adult tissues, but re-induced following injury. This study aimed to evaluate serum TNC in predicting mortality in critically ill patients with multiple organ dysfunction. Adult critically ill patients with at least two organs dysfunction and an increase of Sequential Organ Failure Assess (SOFA) score ≥ 2 points within 7 days were prospectively enrolled into two independent cohorts. The emergency (derivation) cohort was a consecutive series and the patients were from Emergency Department. The inpatient (validation) cohort was a convenience series and the patients were from medical wards. Their serum samples at the first 24 h after enrollment were collected and subjected to TNC measurement using ELISA. The association between serum TNC level and 28-day all-cause mortality was investigated, and then the predictive value of serum TNC was analyzed. A total of 110 patients with a median age of 64 years (53, 73) were enrolled in the emergency cohort. Compared to the survivors, serum TNC in the non-survivors was significantly higher (467.7 vs. 197.5 ng/ml, < 0.001). Multivariate logistic regression analysis revealed that the association between serum TNC and 28-day mortality was independent of sepsis or critical illness scores such as SOFA, Acute Physiology and Chronic Health Evaluation (APACHE II), and Simplified Acute Physiology Score (SAPS II), respectively ( < 0.001 for each). The area under receiver operating characteristic curve of serum TNC for predicting mortality was 0.803 (0.717-0.888) ( < 0.001), similar with SOFA 0.808 (0.725-0.891), APACHE II 0.762 (0.667-0.857), and SAPS II 0.779 (0.685-0.872). The optimal cut-off value of serum TNC was 298.2 ng/ml. Kaplan-Meier analysis showed that the survival of patients with serum TNC ≥ 300 ng/ml was significantly worse than that of patients with serum TNC < 300 ng/ml. This result was validated in the inpatient cohort. The sensitivity and specificity of serum TNC ≥ 300 ng/ml for predicting mortality were 74.3 and 74.7% in the emergency cohort, and 63.0 and 70.1% in the inpatient cohort, respectively. Serum TNC was associated with mortality in critically ill patients with multiple organ dysfunction, and would be used as a prognostic tool for predicting mortality in this population.
多器官功能障碍是一种病因多样的复杂且致命的临床特征，通常以多器官组织损伤为特点。腱生蛋白-C（TNC）是一种基质细胞蛋白，在大多数成人组织中很少表达，但在损伤后会重新诱导表达。本研究旨在评估血清TNC在预测多器官功能障碍重症患者死亡率方面的价值。前瞻性纳入了至少有两个器官功能障碍且在7天内序贯器官衰竭评估（SOFA）评分增加≥2分的成年重症患者，分为两个独立队列。急诊（衍生）队列是连续系列，患者来自急诊科。住院（验证）队列是便利系列，患者来自内科病房。收集入组后最初24小时的血清样本，采用酶联免疫吸附测定法（ELISA）检测TNC。研究血清TNC水平与28天全因死亡率之间的关联，然后分析血清TNC的预测价值。急诊队列共纳入110例患者，中位年龄为64岁（53，73）。与幸存者相比，非幸存者的血清TNC显著更高（467.7对197.5 ng/ml，<0.001）。多因素逻辑回归分析显示，血清TNC与28天死亡率之间的关联分别独立于脓毒症或重症疾病评分，如SOFA、急性生理与慢性健康状况评分系统（APACHE II）和简化急性生理学评分（SAPS II）（各<0.001）。血清TNC预测死亡率的受试者工作特征曲线下面积为0.803（0.717 - 0.888）（<0.001），与SOFA的0.808（0.725 - 0.891）、APACHE II的0.762（0.667 - 0.857）和SAPS II的0.779（0.685 - 0.872）相似。血清TNC的最佳截断值为298.2 ng/ml。Kaplan-Meier分析显示，血清TNC≥300 ng/ml患者的生存率显著低于血清TNC<300 ng/ml的患者。该结果在住院队列中得到验证。血清TNC≥300 ng/ml预测死亡率的敏感性和特异性在急诊队列中分别为74.3%和74.7%，在住院队列中分别为63.0%和70.1%。血清TNC与多器官功能障碍重症患者的死亡率相关，可作为该人群预测死亡率的预后工具。
