Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
Med Princ Pract. 2023;32(2):133-142. doi: 10.1159/000530631. Epub 2023 Apr 17.
Despite improved risk stratification tools and identification of novel biomarkers for the diagnosis and prognosis in patients with sepsis, sepsis-related mortality has not significantly improved during the past years. This study investigates the diagnostic and prognostic role of the plasma albumin and cholinesterase (ChE) in patients with sepsis and septic shock.
Consecutive patients with sepsis and septic shock from 2019 to 2021 were included at one institution. Blood samples were obtained on the day of disease onset (day 1), and on days 2, 3, 5, and 7 thereafter. The diagnostic value of ChE for the diagnosis of a septic shock was compared to albumin and the prognostic value of the albumin and the ChE for 30-day all-cause mortality was tested.
239 patients were included with a median albumin level of 21.4 g/dL and a median ChE of 5004 U/L on admission. With an area under the curve (AUC) of 0.641-0.762 on days 3 and 5, the ChE was associated with moderate but better diagnostic discrimination between sepsis and septic shock than albumin. Furthermore, ChE was able to discriminate between 30-day non-survivors and survivors (range of AUC 0.612-0.686). Patients with a ChE below the median had higher rates of 30-days all-cause mortality in comparison to patients with a ChE above the median (65 vs. 42%, log rank p = 0.001; HR = 1.820; 95% CI = 1.273-2.601; p = 0.001), which was still demonstrated after multivariable adjustment.
The level of ChE was associated with moderate diagnostic and prognostic accuracy in patients with sepsis and septic shock, whereas albumin was not.
尽管在脓毒症患者的风险分层工具和新型生物标志物的诊断和预后方面取得了进展，但过去几年中，脓毒症相关死亡率并未显著改善。本研究旨在探讨脓毒症和感染性休克患者血浆白蛋白和胆碱酯酶（ChE）的诊断和预后作用。
本研究纳入了 2019 年至 2021 年期间在一家机构就诊的连续脓毒症和感染性休克患者。在发病当天（第 1 天）以及随后的第 2、3、5 和 7 天采集血液样本。比较了 ChE 对诊断感染性休克的诊断价值与白蛋白的差异，并检测了白蛋白和 ChE 对 30 天全因死亡率的预后价值。
本研究共纳入了 239 例患者，入院时的白蛋白中位数为 21.4 g/dL，ChE 中位数为 5004 U/L。第 3 和第 5 天的曲线下面积（AUC）为 0.641-0.762，ChE 与白蛋白相比，对脓毒症和感染性休克的诊断具有中等但更好的鉴别能力。此外，ChE 能够区分 30 天内的非幸存者和幸存者（AUC 范围为 0.612-0.686）。与 ChE 中位数以上的患者相比，ChE 中位数以下的患者 30 天全因死亡率更高（65%比 42%，对数秩检验 p=0.001；HR=1.820；95%CI=1.273-2.601；p=0.001），这一结果在多变量调整后仍然成立。
ChE 水平与脓毒症和感染性休克患者的中等诊断和预后准确性相关，而白蛋白则不然。
