Department of Critical Care Medicine, The 908th Hospital of Chinese Logistical Support Force, Nanchang 330002, China.
Nanchang Key Laboratory of Thrombosis and Hemostasis, Nanchang 330002, China.
Dis Markers. 2022 Apr 4;2022:9364037. doi: 10.1155/2022/9364037. eCollection 2022.
Sepsis can progress to septic shock and death, and identifying biomarkers of this progression may permit timely intervention to prevent it. This study explored whether levels of tissue-type plasminogen activator-inhibitor complex (t-PAIC) in serum can predict septic shock early.
We retrospectively analyzed 311 sepsis patients who had been admitted to the intensive care unit (ICU) at our tertiary care hospital between May 2018 and April 2021, and we divided them into those who progressed to septic shock ( = 203) or not ( = 108) based on sepsis-3 definition. After matching patients in the two groups based on propensity scoring, we screened for risk factors of septic shock using logistic regression. We assessed potential predictors of such shock based on the area under the receiver-operating characteristic curve (AUC), Kaplan-Meier survival curves, and correlation analysis.
After propensity score matching to generate two equal groups of 108 patients, we found that serum t-PAIC was significantly higher in septic shock patients. Uni- and multivariate logistic regression identified t-PAIC as an independent risk factor for septic shock (OR 1.14, 95% CI 1.09-1.19, < 0.001) and a biomarker that predicted it with an AUC up to 0.875 (95% CI, 0.829-0.920). Based on the optimal cut-off of t-PAIC = 17.9 ng/mL, we found that patients at or above this threshold had significantly higher lactate levels and scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA). Such patients also had significantly worse survival (HR 2.4, 95% CI 1.38-4.34, = 0.004). Spearman's correlation coefficients were 0.66 between t-PAIC and lactate, and 0.52 between t-PAIC and SOFA.
Serum levels of t-PAIC may be an independent risk factor for septic shock, and they may correlate with the severity of such shock.
败血症可发展为感染性休克和死亡，识别这种进展的生物标志物可能有助于及时进行干预以预防其发生。本研究旨在探讨血清组织型纤溶酶原激活物抑制剂复合物（t-PAIC）水平是否能早期预测感染性休克。
我们回顾性分析了 2018 年 5 月至 2021 年 4 月在我院重症监护病房（ICU）收治的 311 例败血症患者，根据败血症-3 定义将其分为进展为感染性休克（n=203）和未进展为感染性休克（n=108）两组。基于倾向评分匹配两组患者后，我们使用 logistic 回归筛选感染性休克的危险因素。我们基于受试者工作特征曲线（ROC）下面积（AUC）、Kaplan-Meier 生存曲线和相关性分析评估了这种休克的潜在预测指标。
经过倾向评分匹配生成两组各 108 例患者后，我们发现感染性休克患者血清 t-PAIC 明显升高。单因素和多因素 logistic 回归均发现 t-PAIC 是感染性休克的独立危险因素（OR 1.14，95%CI 1.09-1.19，<0.001），其预测 AUC 可达 0.875（95%CI，0.829-0.920）。基于 t-PAIC=17.9ng/ml 的最佳截断值，我们发现该值以上的患者乳酸水平和急性生理学与慢性健康评估 II（APACHE II）和序贯器官衰竭评估（SOFA）评分明显更高。这些患者的生存情况也明显更差（HR 2.4，95%CI 1.38-4.34，=0.004）。Spearman 相关系数分别为 t-PAIC 与乳酸（r=0.66）和 t-PAIC 与 SOFA（r=0.52）。
血清 t-PAIC 水平可能是感染性休克的独立危险因素，与感染性休克的严重程度相关。
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