可溶性白细胞分化抗原14亚型对脓毒性休克患者28d死亡风险预测价值的研究

马力; 孙自国; 沈华强

doi:10.13201/j.issn.1009-5918.2020.03.009

可溶性白细胞分化抗原14亚型对脓毒性休克患者28d死亡风险预测价值的研究

- 巴中市中心医院重症医学科(四川巴中, 636600)

详细信息

通讯作者: 沈华强,E-mail:ylj2201@163.com

中图分类号: R459.7

收稿日期: 2019-10-15

Predictive value of Presepsin in 28-day mortality of patients with sepsis shock

- Department of Critical Care Medicine, Bazhong Central Hospital, Bazhong, Sichuan, 636600, China

More Information

Corresponding author: SHEN Huaqiang, E-mail: ylj2201@163.com

Received Date: 15 October 2019

摘要

摘要: 目的:探讨可溶性白细胞分化抗原14亚型(sCD14-ST,Presepsin)对脓毒性休克患者28 d死亡风险的预测价值。方法:回顾性分析2017-01—2019-03期间我科收治的119例脓毒性休克患者的临床资料,根据28 d预后情况分为存活组(72例)和死亡组(47例)。单因素和多因素Logistic回归分析临床资料确定脓毒性休克患者死亡的高危因素。利用受试者工作特征曲线(ROC)评估Presepsin对脓毒性休克患者28 d死亡风险的预测价值。Pearson相关性分析探讨Presepsin与脓毒性休克患者急性生理与慢性健康Ⅱ(APACHEⅡ)评分之间的相关性。结果:脓毒性休克患者病死率为39.49%(47/119),平均年龄(58.26±15.28)岁,男65例(54.54%),女54例(45.45%)。多因素Logistic回归分析显示,Presepsin,Lac,PCT和APACHEⅡ评分是脓毒性休克患者死亡的危险因素。血清Presepsin、PCT和Lac表达水平与APACHEⅡ评分呈正相关(r分别为0.568、0.491和0.456,P<0.05)。Presepsin预测效能的ROC曲线下面积(AUC)为0.913(95%CI:0.858~0.969)最佳截断值为987.61 pg/mL时其诊断敏感度为91.57%,特异度为88.61%。血清Presepsin预测脓毒性休克患者28 d病死率的AUC明显高于APACHEⅡ评分,差异具有统计学意义(Z=5.332,P<0.05)。结论:血清Presepsin升高是脓毒性休克患者死亡的高危因素,对脓毒性休克患者的28 d死亡风险具有良好的预测价值。
- 脓毒性休克 /
- 可溶性白细胞分化抗原14亚型 /
- 预测价值 /
- 病死率
Abstract: Objective:To investigate the predictive value of Presepsin in 28-day mortality of patients with sepsis shock. Method:The clinical data of 119 patients with septic shock admitted to our department from January 2017 to March 2019 were retrospectively analyzed. According to the 28-day prognosis, the patients were divided into the survival group(72 cases) and the non-survival group(47 cases). Multivariate Logistic regression was performed to identify risk factors of 28-day mortality. Receiver operating curve(ROC) test was applied to analyze the predictive value of Presepsin in 28-day mortality of sepsis shock patients. The correlations between Presepsin and Acute Physiology and Chronic Health EvaluationⅡscore(APACHEⅡscore) were analyzed using Pearson correlation analysis. Result:Of the 119 patients included in the study, 65(54.54%) patients were males and 54(45.45%) were females with a mean age of 58.26±15.28 years. The total mortality in 28-day was 39.66%(48/121). Multivariate Logistic regression analysis showed that Presepsin, Lac, PCT, APACHE Ⅱ score were risk factors for death in patients with sepsis shock. Serum Presepsin, PCT and Lac expression levels were positively correlated with APACHE Ⅱ scores(r=0.568, 0.491 and 0.456, respectively, P<0.05). The area under the ROC curve of Presepsin predicted performance was 0.913(95%CI:0.858-0.969). The optimal cutoff value was 98.77% and the specificity was 88.61% when the cutoff value was 987.61 pg/mL. Serum Presepsin predicted AUC of 28-day mortality in patients with septic shock was significantly higher than APACHE Ⅱ score, the difference was statistically significant(Z=5.332, P<0.05).Conclusion:The increased Presepsin at admission was an independently risk factor of 28-day mortality of patients with sepsis shock. Therefore, Presepsin was useful for predicting prognosis of patients with sepsis shock.
- sepsis shock /
- sCD14-ST /
- predictive value /
- mortality

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参考文献(16)

[1]	Levy MM,Dellinger RP,Townsend SR,et al.The Surviving Sepsis Campaign:results of an international guideline-based performance improvement program targeting severe sepsis[J].Intensive Care Med,2010,36:222-231.
[2]	Enguix-Armada A,Escobar-Conesa R,García-De La Torre A,et al.Usefulness of several biomarkers in the management of septic patients:C-reactive protein,procalcitonin,presepsin and mid-regional pro-adrenomedullin[J].Clin Chem Lab Med,2016,54(1):163-168.
[3]	Singer M,Deutschman CS,Seymour CW,et al.The third international consensus definitions for sepsis and septic shock(sepsis-3)[J].JAMA,2016,315(8):801-810.
[4]	Fleischmann C,Scherag A,Adhikari NK,et al.Assessment of Global Incidence and Mortality of Hospital-treated Sepsis.Current Estimates and Limitations[J].Am J Respir Crit Care Med,2016,193(3):259-272.
[5]	Riche F,Gayat E,Barthelemy R,et al.Reversal of neutrophil-tolymphocyte count ratio in early versus late death from septic shock[J].Crit Care,2015,15(19):439.
[6]	Caglar FNT,Isiksacan N,Biyik I,et al.Presepsin(sCD14-ST):could it be a novel marker for the diagnosis of ST elevation myocardial infarction?[J].Arch Med Sci Atheroscler Dis,2017,2(2):e3-e8.
[7]	Nanno S,Koh H,Katayama T,et al.Plasma Levels of Presepsin(Soluble CD14-subtype)as a Novel Prognostic Marker for Hemophagocytic Syndrome in Hematological Malignancies[J].Intern Med,2016,55(16):2173-2184.
[8]	Chenevier-Gobeaux C,Trabattoni E,Roelens M,et al.Presepsin(sCD14-ST)in emergency department:the need for adapted threshold values?[J].Clin Chim Acta,2014,427(1):34-36.
[9]	El-Madbouly AA,El Sehemawy AA,Eldesoky NA,et al.Utility of presepsin,soluble triggering receptor expressed on myeloid cells-1,and neutrophil CD64 for early detection of neonatal sepsis[J].Infect Drug Resist,2019,12:311-319.
[10]	Enguix-Armada A,Escobar-Conesa R,García-De La Torre A,et al.Usefulness of several biomarkers in the management of septic patients:C-reactive protein,procalcitonin,presepsin and mid-regional pro-adrenomedullin[J].Clin Chem Lab Med,2016,54(1):163-168.
[11]	Masson S,Caironi P,Spanuth E,et al.Presepsin(soluble CD14 subtype)and procalcitonin levels for mortality prediction in sepsis:data from the Albumin Italian Outcome Sepsis trial[J].Crit Care,2014,18:R6.
[12]	毛云,盛孝燕,朱红阳,等.血清降钙素原和可溶性髓样细胞触发受体-1及可溶性CD14亚型水平联合预测脓毒症患者28 d病死率的价值研究[J].中国全科医学,2017,20(36):4494-4500.
[13]	杨彪,王瑶,高婷,等.急性创伤患者监测可溶性白细胞分化抗原14亚型对脓毒症的鉴别诊断及预后评价[J].医学研究杂志,2016,45(8):129-133.
[14]	Behnes M,Bertsch T,Lepiorz D,et al.Diagnostic and prognostic utility of soluble CD14 subtype(presepsin)for severe sepsis and septic shock during the first week of intensive care treatment[J].Crit Care,2014,18(5):507.
[15]	Levy B.Lactate and shock state:the metabolic view[J].Curr Opin Crit Care,2006,12(4):315-321.
[16]	魏亚强,辛田田,张晓艳,等.动脉血乳酸相关指标与初始pH值对脓毒性休克患者预后的判断价值[J].海南医学,2019,30(13):1677-1679.