Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy.
IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy.
Intern Emerg Med. 2023 Aug;18(5):1509-1519. doi: 10.1007/s11739-023-03223-w. Epub 2023 Mar 21.
Unmet needs challenge clinical management of sepsis especially concerning patient profiling, enhancing recovery, and long-term sequelae. Here, we preliminarily focused on sclerostin (SOST) as a candidate biomarker to encompass such a broad range of clinical needs related to sepsis. Seventy-three septic patients were enrolled at internal medicine wards between January 2017 and December 2019 in this pilot study. Clinical examination and blood sample analyses were collected at enrollment and after 7 and 14 days. SOST levels were assessed on serum by ELISA. Thirty-day mortality was set as primary outcome. In-hospital and long-term mortality (2.5 years of median follow-up) were assessed as secondary outcomes. Patients were frail, elderly, and heterogeneous in terms of comorbidity burden. SOST levels were associated with age, cardiovascular comorbidities, and time to early death (30 days). When regression models were built, SOST displayed a high predictive value toward 30-day mortality (OR 13.459 with 95% CI 1.226-148.017) with ever better performance than validated scoring scales for critical ill patients. Such a predictive value of SOST was further confirmed for in-hospital (HR 10.089 with 95% CI 1.375-74.013) and long-term mortality (HR 5.061 with 95% CI 1.379-18.570). SOST levels generally decreased over 7 to 14 days after enrollment (p for trend < 0.001). The degree of this variation further predicted long-term mortality (HR for Δ SOST T0-day 14: 1.006 with 95% CI 1.001-1.011). Our results suggest a role for SOST in both short- and long-time prediction of worse outcome in septic elderly admitted to internal medicine wards.
未满足的需求对脓毒症的临床管理提出了挑战，特别是在患者分析、促进康复和长期后遗症方面。在这里，我们初步将硬骨素 (SOST) 作为一个候选生物标志物，涵盖与脓毒症相关的广泛的临床需求。在这项初步研究中，我们于 2017 年 1 月至 2019 年 12 月在内科病房招募了 73 名脓毒症患者。在入组时和第 7 天和第 14 天采集临床检查和血液样本分析。通过 ELISA 评估血清中的 SOST 水平。30 天死亡率为主要结局。院内和长期死亡率（中位随访 2.5 年）作为次要结局评估。患者体弱、年龄较大且合并症负担不均。SOST 水平与年龄、心血管合并症和早期死亡（30 天）时间相关。当建立回归模型时，SOST 对 30 天死亡率具有较高的预测价值（OR 13.459，95%CI 1.226-148.017），优于用于危重症患者的验证评分量表。SOST 的这种预测价值在院内（HR 10.089，95%CI 1.375-74.013）和长期死亡率（HR 5.061，95%CI 1.379-18.570）方面也得到了进一步证实。SOST 水平在入组后 7 至 14 天内普遍下降（趋势 p<0.001）。这种变化的程度进一步预测了长期死亡率（SOST T0-14 天的 HR 为 1.006，95%CI 为 1.001-1.011）。我们的结果表明，SOST 在预测内科病房收治的老年脓毒症患者短期和长期预后方面发挥作用。
