Nguyen Van Tri, Nguyen-Phan Hong Ngoc, Hoang Bui Bao
Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam.
Department of Anesthesiology of Hue International Medical Center, Hue Central Hospital, Hue City, Vietnam.
Med Arch. 2023;77(6):433-439. doi: 10.5455/medarh.2023.77.433-439.
Thrombomodulin (TM) is a type-1 trans-membrane glycoprotein on endothelial cells which is known to be involved in various biochemical pathways. TM can be detected in biological fluids such as blood and urine under many forms. Soluble thrombomodulin (sTM), consist of various particles of TM, is the predominant agent which is created by enzymatic or chemical catalysis of the whole protein under divergent conditions. TM plays a vital role in protein C system and is crucial in the pathogenesis of Sepsis.
To identify the serum level of soluble thrombomodulin (sTM) in groups of patients: sepsis and septic shock including their survival and fatal in-hospital outcome; and validate the death prediction of serum sTM in patients with sepsis.
This prospective observational study was conducted in 63 patients who were diagnosed with sepsis, septic shock according to Sepsis 3 criteria at the ICU Department of Hue Central Hospital, Vietnam, from 3/2022 to 3/2023.
Twenty participants developed septic shock (31.7%), morality within 28-days was 19 patients (30.2%), 22 patients complicated with acute kidney injury that necessitated renal replacement therapy (34.9%), 30 patients required mechanical ventilation (47.6%), the median length of ICU stay was 8 (3-28) days. Serum level of lactate and creatinine were significantly higher in septic shock group compared with sepsis and survival group (p<0.05). The median sTM level in septic shock group and fatal group were 4.68(3.38-6.46) ng/mL and 4.68 (1.69-6.46) ng/mL, respectively. These results were significantly higher than sepsis group [3.62 (1.51-1.94) ng/mL] and survival group [3.73 (1.51-5.9) ng/mL] (p<0.05). The death predictive power of DIC score, APACHE II score, creatinine, sTM and SOFA presented with AUC values of 0.723, 0.726, 0.777, 0.803 and 0.807, respectively. There were no significant difference of serum level IL-6 and PCT between survival and fatal group. The median DIC score in fatal group was 7 (3-7), which was significantly higher than survival group 4 (2-7) (p= 0.001).
Sepsis is a common diagnosis among ICU settings which links the critically ill patients to higher complications and mortalities. Serum level of sTM in septic shock and fatal groups were significantly higher than sepsis and survival groups. sTM is a reliable marker and should be used in predict severity and mortality in sepsis patients.
血栓调节蛋白（TM）是内皮细胞上的一种I型跨膜糖蛋白，已知其参与多种生化途径。TM可以多种形式在血液和尿液等生物体液中被检测到。可溶性血栓调节蛋白（sTM）由TM的各种颗粒组成，是在不同条件下通过全蛋白的酶促或化学催化产生的主要物质。TM在蛋白C系统中起着至关重要的作用，在脓毒症的发病机制中也至关重要。
确定脓毒症和脓毒性休克患者组中可溶性血栓调节蛋白（sTM）的血清水平，包括其生存情况和院内死亡结局；并验证血清sTM对脓毒症患者死亡的预测价值。
这项前瞻性观察性研究于2022年3月至2023年3月在越南顺化中央医院重症监护室对63例根据脓毒症3标准诊断为脓毒症、脓毒性休克的患者进行。
20名参与者发生脓毒性休克（31.7%），28天内死亡19例（30.2%），22例并发急性肾损伤需要肾脏替代治疗（34.9%），30例需要机械通气（47.6%），重症监护病房住院时间中位数为8（3 - 28）天。脓毒性休克组的血清乳酸和肌酐水平显著高于脓毒症组和生存组（p<0.05）。脓毒性休克组和死亡组的sTM水平中位数分别为4.68（3.38 - 6.46）ng/mL和4.68（,1.69 - 6.46）ng/mL。这些结果显著高于脓毒症组[3.62（1.51 - 1.94）ng/mL]和生存组[3.73（1.51 - 5.9）ng/mL]（p<0.05）。DIC评分、APACHE II评分、肌酐、sTM和SOFA的死亡预测能力分别以AUC值0.723、0.726、0.777、0.803和0.807呈现。生存组和死亡组之间血清IL - 6和PCT水平无显著差异。死亡组的DIC评分中位数为7（3 - 7），显著高于生存组的4（2 - 7）（p = 0.001）。
脓毒症是重症监护病房中常见的诊断，使危重症患者面临更高的并发症和死亡率。脓毒性休克组和死亡组的血清sTM水平显著高于脓毒症组和生存组。sTM是一个可靠的标志物，应用于预测脓毒症患者的严重程度和死亡率。
