Chen Long, Lin Xiao, Yu Xing, Yang Chunxia, Li Rui, Guo Qingqing, Shi Jingshi, Liao Xiuyu, Chen Xiaoli, Ma Zengyi, Lin Jiandong
Department of Neurosurgery & Neurocritical Care, Huashan Hospital, Fudan University, Shanghai, China.
Intensive Care Unit, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Front Cell Infect Microbiol. 2025 Mar 7;15:1529917. doi: 10.3389/fcimb.2025.1529917. eCollection 2025.
The present study was conducted to reappraise the prognostic value of decoy receptor 3 (DcR3) for patients with sepsis and septic shock according to the latest Sepsis-3 definitions.
Subjects suffering from sepsis or septic shock were enrolled within 6 h of admission. The Sequential Organ Failure Assessment (SOFA) score and the plasma levels of DcR3, C-reactive protein, procalcitonin, and interleukin-6 were measured. Group comparisons were made based on the survival status on day 28 after onset. Predictors of mortality were assessed using the Cox proportional hazard models, and survival curves were plotted with the Kaplan-Meier method. Discriminative performances of single and combined indicators were evaluated via the areas under receiver operating characteristic curves.
Among 143 eligible sepsis cases, 77 developed septic shock, and the 28-day mortality rates were 32.2% and 45.5%, respectively. Regardless of the population (all sepsis or septic shock), non-survivors exhibited significantly higher DcR3 levels compared to survivors (median 4.19 vs. 2.64 ng/mL and 4.37 vs. 3.18 ng/mL, respectively; < 0.001 and p = 0.002, respectively). DcR3 levels were most correlated with organ dysfunction presented by SOFA scores (correlation coefficient = 0.347 and 0.308, respectively; p = 0.001 and 0.016, respectively) but did not differ among the various pathogenic microbes of infection. Multivariate Cox regression identified DcR3 as an independent predictor of mortality [hazard ratio (95% confidence interval): 1.570 (1.048-2.352) and 1.828 (1.047-3.194), respectively; p = 0.029 and 0.034, respectively]. Kaplan-Meier analysis showed that elevated DcR3 concentrations were associated with significantly lower survival rates (p = 0.001 and 0.013, respectively). The areas under receiver operating characteristic curves of DcR3 alone for predicting outcome were superior to that of the other three biomarkers (0.731 and 0.711, respectively) and could be further improved when coupled with SOFA scores (0.803 and 0.784, respectively).
DcR3 is a valuable prognostic biomarker for sepsis and septic shock, offering the potential to predict 28-day mortality in clinical settings.
根据最新的脓毒症-3定义，重新评估诱饵受体3（DcR3）对脓毒症和脓毒性休克患者的预后价值。
脓毒症或脓毒性休克患者在入院6小时内入组。测量序贯器官衰竭评估（SOFA）评分以及DcR3、C反应蛋白、降钙素原和白细胞介素-6的血浆水平。根据发病后第28天的生存状态进行组间比较。使用Cox比例风险模型评估死亡率的预测因素，并用Kaplan-Meier方法绘制生存曲线。通过受试者工作特征曲线下面积评估单一指标和联合指标的判别性能。
在143例符合条件的脓毒症病例中，77例发生了脓毒性休克，28天死亡率分别为32.2%和45.5%。无论总体情况（所有脓毒症或脓毒性休克）如何，与幸存者相比，非幸存者的DcR3水平显著更高（中位数分别为4.19对2.64 ng/mL和4.37对3.18 ng/mL；分别为p<0.001和p = 0.002）。DcR3水平与SOFA评分所呈现的器官功能障碍相关性最强（相关系数分别为0.347和0.308；分别为p = 0.001和p = 0.016），但在不同感染致病微生物之间并无差异。多因素Cox回归分析确定DcR3为死亡率的独立预测因素[风险比（95%置信区间）：分别为1.570（1.048 - 2.352）和1.828（1.047 - 3.194）；分别为p = 0.029和p = 0.034]。Kaplan-Meier分析表明，DcR3浓度升高与生存率显著降低相关（分别为p = 0.001和p = 0.013）。单独使用DcR3预测结局的受试者工作特征曲线下面积优于其他三种生物标志物（分别为0.731和0.711），与SOFA评分联合时可进一步提高（分别为0.803和0.784）。
DcR3是脓毒症和脓毒性休克的有价值的预后生物标志物，在临床环境中具有预测28天死亡率的潜力。
