Elevated biomarkers of endothelial dysfunction/activation at ICU admission are associated with sepsis development
Elevated biomarkers of endothelial dysfunction/activation at ICU admission are associated with sepsis development
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DOI：
10.1016/j.cyto.2014.06.010
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发表时间：
2014-10-01
期刊：
影响因子：
3.8
通讯作者：
Kotanidou, Anastasia
中科院分区：
文献类型：
--
作者：
Vassiliou, Alice G.;Mastora, Zafeiria;Kotanidou, Anastasia
广泛的内皮细胞激活和功能障碍通常出现在临床败血症之前。几种内皮相关分子已被研究为脓毒症早期诊断和/或预后的潜在生物标志物，根据研究设计的不同而得出不同的结果。这些因子包括E-和P-选择素等内皮细胞黏附分子、细胞间黏附分子-1、血管内皮细胞钙粘附素、血管生成素-1和血管内皮生长因子等生长因子以及von Willebrand因子抗原。我们试图调查在ICU入院时测量的血管内皮细胞激活/功能障碍的循环生物标志物是否与随后的脓毒症发展相关。对89名住进普通ICU的危重患者进行了研究，这些患者符合无脓毒症标准。在ICU后24小时内检测血浆或血清中上述内皮衍生分子的水平，并测量或记录急性生理学与慢性健康评估(APACHE)II和序贯器官衰竭评估(SOFA)评分、年龄、性别、诊断类别、循环降钙素原(PCT)和C反应蛋白(CRP)水平。两组患者血清E-、P-选择素水平、循环PCT、SOFA评分及诊断类别比较差异均有统计学意义。多因素Logistic回归分析表明，SE和SP-选择素水平升高和SOFA与脓毒症发生的风险增加相关，而多因素COX回归分析发现SE和SP-选择素水平是与脓毒症出现时间相关的唯一参数[RR=1.026，95%CI=1.008~1.045，p=0.005；RR=1.005(单位为单位)，95%CI=1.000~1.010，p=0.034]。当对创伤患者进行独立分析时，多元COX回归分析显示sE-选择素是唯一与脓毒症随时间发展相关的分子(RR=1.041，95%CI：1.019-1.065；p<；0.001)。总而言之，在我们的队列中，在ICU入院时测量到的循环内皮细胞黏附分子E-和P-选择素的高水平似乎与脓毒症的发展及时相关。(C)2014爱思唯尔有限公司。保留所有权利。
Widespread endothelial activation and dysfunction often precede clinical sepsis. Several endothelium-related molecules have been investigated as potential biomarkers for early diagnosis and/or prognosis of sepsis, providing different results depending on study designs. Such factors include endothelial adhesion molecules like E- and P-selectin, and the intercellular adhesion molecule-1, vascular endothelial cadherin, growth factors such as Angiopoietin-1 and -2 and vascular endothelial growth factor, as well as von Willebrand factor antigen. We sought to investigate whether circulating biomarkers of endothelial activation/dysfunction measured at ICU admission are associated with subsequent sepsis development.Eighty-nine critically-ill patients admitted to a general ICU who met no sepsis criteria were studied. Plasma or serum levels of the above-mentioned endothelium-derived molecules were measured during the first 24 h post ICU; acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, age, sex, diagnostic category, and circulating procalcitonin (PCT) and C-reactive protein (CRP) levels were additionally measured or recorded.Forty-five patients subsequently became septic and 44 did not. Soluble (s) E- and P-selectin levels, circulating PCT, SOFA score and diagnostic category were significantly different between the two groups. Multiple logistic regression analysis associated elevated SE- and sP-selectin levels and SOFA with an increased risk of developing sepsis, while multiple Cox regression analysis identified SE- and sP-selectin levels as the only parameters related to sepsis appearance with time [RR = 1.026, 95%CI = 1.008-1.045, p = 0.005; RR = 1.005 (by 10 units), 95%CI = 1.000-1.010, p = 0.034, respectively]. When trauma patients were independently analyzed, multiple Cox regression analysis revealed sE-selectin to be the only molecule associated with sepsis development with time (RR = 1.041, 95%CI: 1.019-1.065; p < 0.001).In conclusion, in our cohort of initially non-septic critically-ill patients, high levels of the circulating endothelial adhesion molecules E- and P-selectin, measured at ICU admission, appear to be associated with sepsis development in time. (C) 2014 Elsevier Ltd. All rights reserved.