富含组氨酸的糖蛋白作为重症监护病房患者术后并发症的新型预测生物标志物：一项前瞻性观察研究。

Histidine-rich glycoprotein as a novel predictive biomarker of postoperative complications in intensive care unit patients: a prospective observational study.

机构信息

Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.

出版信息

BMC Anesthesiol. 2022 Jul 20;22(1):232. doi: 10.1186/s12871-022-01774-7.

DOI:10.1186/s12871-022-01774-7

PMID:35858852

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9296898/

Abstract

BACKGROUND

Decrease in histidine-rich glycoprotein (HRG) was reported as a cause of dysregulation of the coagulation-fibrinolysis and immune systems, leading to multi-organ failure, and it may be a biomarker for sepsis, ventilator-associated pneumonia, preeclampsia, and coronavirus disease 2019. However, the usefulness of HRG in perioperative management remains unclear. This study aimed to assess the usefulness of HRG as a biomarker for predicting postoperative complications.

METHODS

This was a single-center, prospective, observational study of 150 adult patients who were admitted to the intensive care unit after surgery. Postoperative complications were defined as those having a grade II or higher in the Clavien-Dindo classification, occurring within 7 days after surgery. The primary outcome was HRG levels in the patients with and without postoperative complications. The secondary outcome was the ability of HRG, white blood cell, C-reactive protein, procalcitonin, and presepsin to predict postoperative complications. Data are presented as number and median (interquartile range).

RESULTS

The incidence of postoperative complications was 40%. The HRG levels on postoperative day 1 were significantly lower in patients who developed postoperative complications (n = 60; 21.50 [18.12-25.74] µg/mL) than in those who did not develop postoperative complications (n = 90; 25.46 [21.05-31.63] µg/mL). The Harrell C-index scores for postoperative complications were HRG, 0.65; white blood cell, 0.50; C-reactive protein, 0.59; procalcitonin, 0.73; and presepsin, 0.73. HRG was independent predictor of postoperative complications when adjusted for age, the presence of preoperative cardiovascular comorbidities, American Society of Anesthesiologists Physical Status Classification, operative time, and the volume of intraoperative bleeding (adjusted hazard ratio = 0.94; 95% confidence interval, 0.90-0.99).

CONCLUSIONS

The HRG levels on postoperative day 1 could predict postoperative complications. Hence, HRG may be a useful biomarker for predicting postoperative complications.

摘要

背景

组氨酸丰富糖蛋白（HRG）的减少被报道为导致凝血-纤溶和免疫系统失调、多器官衰竭的原因，它可能是脓毒症、呼吸机相关性肺炎、子痫前期和 2019 年冠状病毒病的生物标志物。然而，HRG 在围手术期管理中的用途尚不清楚。本研究旨在评估 HRG 作为预测术后并发症的生物标志物的有用性。

方法

这是一项针对 150 名成年患者的单中心、前瞻性、观察性研究，这些患者在手术后被收入重症监护病房。术后并发症定义为 Clavien-Dindo 分级为 II 级或更高的并发症，发生在手术后 7 天内。主要结局是有和无术后并发症的患者的 HRG 水平。次要结局是 HRG、白细胞、C 反应蛋白、降钙素原和前降钙素预测术后并发症的能力。数据以数字和中位数（四分位距）表示。

结果

术后并发症的发生率为 40%。发生术后并发症的患者（n=60）在术后第 1 天的 HRG 水平明显低于未发生术后并发症的患者（n=90）（21.50[18.12-25.74]µg/mL 比 25.46[21.05-31.63]µg/mL）。术后并发症的 Harrell C 指数评分分别为 HRG，0.65；白细胞，0.50；C 反应蛋白，0.59；降钙素原，0.73；前降钙素，0.73。在校正年龄、术前心血管合并症、美国麻醉医师协会身体状况分类、手术时间和术中出血量后，HRG 是术后并发症的独立预测因子（调整后的危险比=0.94；95%置信区间，0.90-0.99）。