Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, & Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation. Clinical Center for Medicine in Acute Infection, Capital Medical University, Beijing, 100020, China.
BMC Anesthesiol. 2024 Jan 19;24(1):32. doi: 10.1186/s12871-023-02381-w.
The prognostic performance of soluble CD40L (sCD40L) for illness severity in infectious diseases is rarely reported. We investigated the ability of sCD40L combined with Acute Physiology and Chronic Health Evaluation II (APACHE II) score to evaluate mortality in septic patients in the emergency department(ED).
We enrolled 222 septic patients in the ED of Beijing Chao-Yang Hospital from October 2020 to April 2021. Their serum sCD40L, PCT, lactate (Lac), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score were used to predict the prognosis of septic patients in terms of 28-day mortality. Serum sCD40L was detected by Human XL Cytokine Luminex. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to assess the prognostic value of the variables.
One hundred ninety-five patients met the inclusion criteria, divided into survival group (55 cases) and non-survival group (140 cases). sCD40L, PCT, Lac, SOFA and APACHE II score were found to independently predict 28-day mortality (P < 0.05). The AUC values of sCD40L, PCT, Lac, SOFA and APACHE II score were 0.662,0.727,0.704, 0.719 and 0.716, respectively. There was no difference in the diagnostic value of sCD40L compared with the PCT, Lac, SOFA score or APACHE II score (Z = 1.19, P = 0.234; Z = 0.77, P = 0.441; Z = 1.05, P = 0.294; Z = 0.97, P = 0.332). However, the combined evaluation of sCD40L + APACHE II (AUC:0.772, Z = 2.10, P = 0.036) was much better than sCD40L alone in predicting 28-day mortality.
The predictive value of sCD40L + APACHE II is better than sCD40L alone for 28-day mortality. sCD40L combined with APACHE II score is valuable for predicting 28-day mortality in elderly patients with sepsis.
可溶性 CD40L（sCD40L）在传染病疾病严重程度中的预后表现很少有报道。我们研究了 sCD40L 联合急性生理学和慢性健康评估 II（APACHE II）评分评估急诊科（ED）败血症患者死亡率的能力。
我们纳入了 2020 年 10 月至 2021 年 4 月在北京朝阳医院 ED 的 222 例败血症患者。使用血清 sCD40L、降钙素原（PCT）、乳酸（Lac）、序贯器官衰竭评估（SOFA）评分和急性生理学和慢性健康评估 II（APACHE II）评分评估这些患者 28 天死亡率的预后。血清 sCD40L 通过 Human XL Cytokine Luminex 检测。使用逻辑回归分析和接收者操作特征（ROC）曲线评估变量的预后价值。
195 名患者符合纳入标准，分为存活组（55 例）和非存活组（140 例）。sCD40L、PCT、Lac、SOFA 和 APACHE II 评分均独立预测 28 天死亡率（P<0.05）。sCD40L、PCT、Lac、SOFA 和 APACHE II 评分的 AUC 值分别为 0.662、0.727、0.704、0.719 和 0.716。sCD40L 与 PCT、Lac、SOFA 评分或 APACHE II 评分的诊断价值无差异（Z=1.19，P=0.234；Z=0.77，P=0.441；Z=1.05，P=0.294；Z=0.97，P=0.332）。然而，sCD40L+APACHE II 的联合评估（AUC：0.772，Z=2.10，P=0.036）在预测 28 天死亡率方面优于 sCD40L 单独评估。
sCD40L+APACHE II 的预测价值优于 sCD40L 单独评估 28 天死亡率。sCD40L 联合 APACHE II 评分对预测老年败血症患者 28 天死亡率具有重要价值。
