Lorente Leonardo, Martín María M, Ortiz-López Raquel, Pérez-Cejas Antonia, Gómez-Bernal Fuensanta, González-Mesa Adriana, Jiménez Alejandro, González-Rivero Agustín F
Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320, Tenerife, Spain.
Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Crta Rosario s/n., 38010, Santa Cruz Tenerife, Spain.
Wien Klin Wochenschr. 2023 Feb;135(3-4):75-79. doi: 10.1007/s00508-022-02059-2. Epub 2022 Jul 19.
There are few data on caspase‑9 (intrinsic apoptosis pathway initiating caspase) in septic patients. Higher serum caspase‑9 levels in septic patients than in healthy subjects have been found. However, there are no data on the prognosis of septic patients and blood caspase‑9 concentrations. Therefore, the objective of this study was to analyze the potential association between blood caspase‑9 concentrations and prognosis in septic patients.
Three Spanish hospitals participated in the recruitment of septic patients admitted to intensive care units in this observational and prospective study. Serum caspase‑9 concentrations were determined at the time of sepsis diagnosis. The 30-day mortality was the outcome variable.
Higher Acute Phisiology and Chronic Health Evaluation(APACHE)-II (p < 0.001), Sepsis-related Organ Failure Assessment score (SOFA) (p < 0.001), serum lactic acid levels (p = 0.001), serum caspase‑9 levels (p < 0.001), age (p < 0.001), International normalized ratio (INR) (p = 0.001), rate of septic shock (p = 0.001), Activated partial thromboplastin time (aPTT) (p = 0.03), rate of diabetes mellitus (p = 0.04), and lower platelet counts (p = 0.01) were found in non-surviving (n = 80) than in surviving patients (n = 134). Multiple logistic regression analysis showed an association between serum caspase‑9 concentrations and mortality (Odds Ratio (OR) = 1.985; 95% Confidence Interval (CI) = 1.359-2.900; p < 0.001) regardless of age, SOFA, lactic acid and septic shock and history of diabetes mellitus. No significant differences were found when we compared area under ROC curves of serum caspase‑9 with SOFA (p = 0.92) and with lactic acid (p = 0.59).
The main novel finding of our study was the association between blood caspase‑9 concentrations and septic patient prognosis. However, our study showed some limitations (for example, the absence of data in respect to execution of Surviving Sepsis Campaign bundles); thus, more research could be interesting to confirm our preliminary findings.
关于脓毒症患者中半胱天冬酶-9（启动内源性凋亡途径的半胱天冬酶）的数据较少。已发现脓毒症患者的血清半胱天冬酶-9水平高于健康受试者。然而，关于脓毒症患者的预后与血液半胱天冬酶-9浓度之间的数据尚无报道。因此，本研究的目的是分析脓毒症患者血液半胱天冬酶-9浓度与预后之间的潜在关联。
三家西班牙医院参与了这项观察性前瞻性研究，招募入住重症监护病房的脓毒症患者。在脓毒症诊断时测定血清半胱天冬酶-9浓度。30天死亡率为观察指标。
与存活患者（n = 134）相比，非存活患者（n = 80）的急性生理与慢性健康状况评分系统（APACHE）-II（p < 0.001）、脓毒症相关器官功能衰竭评估评分（SOFA）（p < 0.001）、血清乳酸水平（p = 0.001）、血清半胱天冬酶-9水平（p < 0.001）、年龄（p < 0.001）、国际标准化比值（INR）（p = 0.001）、脓毒性休克发生率（p = 0.001）、活化部分凝血活酶时间（aPTT）（p = 0.03）、糖尿病发生率（p = 0.04）更高，而血小板计数更低（p = 0.01）。多因素逻辑回归分析显示，无论年龄、SOFA评分、乳酸水平、脓毒性休克及糖尿病史如何，血清半胱天冬酶-9浓度与死亡率之间均存在关联（比值比（OR）= 1.985；95%置信区间（CI）= 1.359 - 2.900；p < 0.001）。当比较血清半胱天冬酶-9与SOFA（p = 0.92）以及与乳酸（p = 0.59）的ROC曲线下面积时，未发现显著差异。
本研究的主要新发现是血液半胱天冬酶-9浓度与脓毒症患者预后之间的关联。然而，我们的研究存在一些局限性（例如，缺乏关于脓毒症存活策略执行情况的数据）；因此，需要更多研究来证实我们的初步发现。
