Department of Cardiac Anaesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
Department of Acute Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
Neurol Neurochir Pol. 2024;58(5):512-518. doi: 10.5603/pjnns.99042. Epub 2024 Aug 5.
Sepsis-associated brain dysfunction is a common organ dysfunction in sepsis. The main goal of this study was to verify whether the combined assessment of central nervous system injury markers (i.e. S100B, NSE, GFAP) and disease severity as per the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) classification systems, would increase the accuracy of death prediction in septic shock.
Markers of neuronal damage were determined in 55 patients diagnosed with septic shock with no previous neurological disease. Clinical data was collected and the scores on the APACHE II, SAPS II and SOFA prognostic scales were calculated. Death before discharge from the Intensive Care Unit (ICU) was established as the endpoint.
Nineteen patients (35%) died before ICU discharge. Patients who died had significantly higher S100B and NSE values, and APACHE II, SAPS II and SOFA scores (P< 0.05 for all). At the time of septic shock diagnosis, NSE levels more accurately predicted the risk of death before ICU discharge than S100B. However, NSE had no better predictive value for short-term mortality than APACHE II, SAPS II and SOFA. Adding C-reactive protein (CRP) and S100B concentrations to the APACHE II score created a predictive model with 95% mortality accuracy (AUC = 0.95; 95%CI 0.85-0.99; P = 0.03).
The assessment of acute neuronal injury plays an important role in prognostication in patients with septic shock. The concentration of S100B protein in combination with APACHE II score and concentration of CRP more accurately predicts mortality than the APACHE II alone.
脓毒症相关脑功能障碍是脓毒症中常见的器官功能障碍。本研究的主要目的是验证中枢神经系统损伤标志物（即 S100B、NSE、GFAP）的联合评估以及根据急性生理学和慢性健康评估 II（APACHE II）、简化急性生理学评分 II（SAPS II）和序贯器官衰竭评估（SOFA）分类系统评估疾病严重程度是否会提高脓毒性休克患者死亡预测的准确性。
测定了 55 例诊断为脓毒性休克且无先前神经系统疾病的患者的神经元损伤标志物。收集临床数据，并计算 APACHE II、SAPS II 和 SOFA 预后评分。从重症监护病房（ICU）出院前死亡被确立为终点。
19 例（35%）患者在 ICU 出院前死亡。死亡患者的 S100B 和 NSE 值以及 APACHE II、SAPS II 和 SOFA 评分显著更高（所有 P<0.05）。在脓毒性休克诊断时，NSE 水平比 S100B 更能准确预测 ICU 出院前死亡的风险。然而，与 APACHE II、SAPS II 和 SOFA 相比，NSE 对短期死亡率没有更好的预测价值。将 C 反应蛋白（CRP）和 S100B 浓度添加到 APACHE II 评分中创建了一个具有 95%死亡率准确性的预测模型（AUC=0.95；95%CI 0.85-0.99；P=0.03）。
评估急性神经元损伤在脓毒性休克患者的预后中起着重要作用。S100B 蛋白浓度与 APACHE II 评分和 CRP 浓度相结合比单独使用 APACHE II 更能准确预测死亡率。
