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急诊科收治的脓毒症和脓毒性休克患者死亡率预测生物标志物:谁是优胜者?一项前瞻性研究。

Biomarkers as Predictors of Mortality in Sepsis and Septic Shock for Patients Admitted to Emergency Department: Who Is the Winner? A Prospective Study.

作者信息

Luka Sonia, Golea Adela, Tat Raluca Mihaela, Lupan Mureșan Eugenia Maria, Voicescu George Teo, Vesa Ștefan Cristian, Ionescu Daniela

机构信息

Department 6 Surgery, Discipline of Emergency Medicine, Iuliu Hatieganu, Faculty of Medicine, University of Medicine and Pharmacy, 3-5 Clinicilor Street, 400347 Cluj-Napoca, Romania.

Clinical Emergency County Hospital, 3-5 Clinicilor Street, 400347 Cluj-Napoca, Romania.

出版信息

J Clin Med. 2024 Sep 24;13(19):5678. doi: 10.3390/jcm13195678.

Abstract

: Sepsis and septic shock remain significant contributors to high early mortality rates among patients admitted to the emergency department (ED). The objective of this study was to identify among newer biomarkers those with the highest sensitivity in early mortality prediction. : This prospective, unicentric, observational study enrolled 47 adult patients admitted to the ED between November 2020 and December 2022. This study monitored the kinetics of the older and newer biomarkers, including azurocidin (AZU1), soluble triggering receptor expressed on myeloid cells (sTREM), soluble urokinase-type plasminogen activator receptor (suPAR), high-sensitivity C-reactive protein (hsCRP), procalcitonin (PCT), and interleukin-6 (IL-6), and their capacity in predicting mortality. : SuPAR showed the most significant predictive utility for early prognosis of mortality in the ED, with an area under the curve (AUC) of 0.813 (95% CI: 0.672 to 0.912), a cutoff value > 8168 ng/mL, sensitivity of 75%, and specificity of 81.48% ( < 0.001). IL-6 and PCT showed comparable prognostic accuracy, whereas hsCRP and AZU1 demonstrated lower predictive performance. : In our study, suPAR, IL-6, and PCT showed good predictive value for short-term mortality in sepsis and septic shock patients.

摘要

脓毒症和脓毒性休克仍然是急诊科(ED)收治患者早期高死亡率的重要因素。本研究的目的是在新型生物标志物中确定那些在早期死亡率预测中具有最高敏感性的标志物。

这项前瞻性、单中心观察性研究纳入了2020年11月至2022年12月期间在急诊科收治的47例成年患者。本研究监测了包括天青杀素(AZU1)、髓系细胞表面可溶性触发受体(sTREM)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)、高敏C反应蛋白(hsCRP)、降钙素原(PCT)和白细胞介素-6(IL-6)在内的新旧生物标志物的动力学及其预测死亡率的能力。

SuPAR对急诊科死亡率的早期预后显示出最显著的预测效用,曲线下面积(AUC)为0.813(95%CI:0.672至0.912),临界值>8168 ng/mL,敏感性为75%,特异性为81.48%(P<0.001)。IL-6和PCT显示出相当的预后准确性,而hsCRP和AZU1的预测性能较低。

在我们的研究中,suPAR、IL-6和PCT对脓毒症和脓毒性休克患者的短期死亡率显示出良好的预测价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/21ab/11477125/3ea1ee418b03/jcm-13-05678-g001.jpg

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