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临床生物标志物谱揭示了脓毒症中的性别差异和死亡因素。

Clinical biomarker profiles reveals gender differences and mortality factors in sepsis.

机构信息

State Key Laboratory of Respiratory Disease, Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.

Guangzhou Laboratory, Guangzhou International Bio Island, Guangzhou, Guangdong, China.

出版信息

Front Immunol. 2024 May 21;15:1413729. doi: 10.3389/fimmu.2024.1413729. eCollection 2024.

Abstract

BACKGROUND

Sepsis is a major contributor to global morbidity and mortality, affecting millions each year. Notwithstanding the decline in sepsis incidence and mortality over decades, gender disparities in sepsis outcomes persist, with research suggesting higher mortality rates in males.

METHODS

This retrospective study aims to delineate gender-specific clinical biomarker profiles impacting sepsis progression and mortality by examining sepsis cases and related clinical data from the past three years. Propensity score matching was used to select age-matched healthy controls for comparison.

RESULTS

Among 265 sepsis patients, a significantly higher proportion were male (60.8%, P<0.001). While mortality did not significantly differ by gender, deceased patients were significantly older (mean 69 vs 43 years, P=0.003), more likely to have hypertension (54% vs 25%, P=0.019), and had higher SOFA scores (mean ~10 vs 4, P<0.01) compared to survivors. Principal Component Analysis (PCA) showed clear separation between sepsis patients and healthy controls. 48 serum biomarkers were significantly altered in sepsis, with Triiodothyronine, Apolipoprotein A, and Serum cystatin C having the highest diagnostic value by ROC analysis. Gender-stratified comparisons identified male-specific (e.g. AFP, HDLC) and female-specific (e.g. Rheumatoid factor, Interleukin-6) diagnostic biomarkers. Deceased patients significantly differed from survivors, with 22 differentially expressed markers; Antithrombin, Prealbumin, HDL cholesterol, Urea nitrogen and Hydroxybutyrate had the highest diagnostic efficiency for mortality.

CONCLUSION

These findings enhance our understanding of gender disparities in sepsis and may guide future therapeutic strategies. Further research is warranted to validate these biomarker profiles and investigate the molecular mechanisms underlying these gender differences in sepsis outcomes.

摘要

背景

脓毒症是全球发病率和死亡率的主要原因,每年影响数百万人。尽管几十年来脓毒症的发病率和死亡率有所下降,但脓毒症结局仍存在性别差异,研究表明男性死亡率更高。

方法

本回顾性研究旨在通过检查过去三年的脓毒症病例和相关临床数据,描绘影响脓毒症进展和死亡率的性别特异性临床生物标志物特征。使用倾向评分匹配选择年龄匹配的健康对照组进行比较。

结果

在 265 例脓毒症患者中,男性比例明显更高(60.8%,P<0.001)。虽然性别对死亡率没有显著影响,但死亡患者年龄明显更大(平均 69 岁比 43 岁,P=0.003),更有可能患有高血压(54%比 25%,P=0.019),SOFA 评分更高(平均约 10 比 4,P<0.01)与幸存者相比。主成分分析(PCA)显示脓毒症患者和健康对照组之间有明显分离。48 种血清生物标志物在脓毒症中发生明显改变,三碘甲状腺原氨酸、载脂蛋白 A 和血清胱抑素 C 通过 ROC 分析具有最高的诊断价值。性别分层比较确定了男性特异性(如 AFP、HDLC)和女性特异性(如类风湿因子、白细胞介素-6)诊断生物标志物。死亡患者与幸存者显著不同,有 22 个差异表达标志物;抗凝血酶、前白蛋白、HDL 胆固醇、尿素氮和羟丁酸对死亡率具有最高的诊断效率。

结论

这些发现增强了我们对脓毒症中性别差异的理解,并可能指导未来的治疗策略。需要进一步研究来验证这些生物标志物特征,并研究脓毒症结局中这些性别差异的分子机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7b35/11148215/a5fa58e2d8c3/fimmu-15-1413729-g001.jpg

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