Complement depletion deteriorates clinical outcomes of severe abdominal sepsis: a conspirator of infection and coagulopathy in crime?
Complement depletion deteriorates clinical outcomes of severe abdominal sepsis: a conspirator of infection and coagulopathy in crime?
复制标题
DOI：
10.1371/journal.pone.0047095
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Li J
中科院分区：
文献类型：
--
作者：
Ren J;Zhao Y;Yuan Y;Han G;Li W;Huang Q;Tong Z;Li J
补体耗竭常发生在脓毒症时，但与严重感染或凝血功能障碍相比常被低估。本研究旨在探讨严重腹腔脓毒症患者补体系统的变化，并评价补体耗竭在严重腹腔脓毒症患者预后中的作用。并探讨了补体耗竭与感染或凝血功能障碍的关系。45例严重腹腔脓毒症患者在转诊至SICU的个人中进行了前瞻性研究。目前推荐的治疗，如早期目标导向复苏，源控制和抗生素治疗，进行。采用急性生理学和慢性健康状况评估II（APACHE II）和脓毒症相关器官衰竭评估（SOFA）评分评估严重程度。观察8次内检测血浆C3、C4、CRP、PCT、D-二聚体等指标。比较补体耗竭组和非补体耗竭组的28天死亡率、住院时间和术后并发症。在研究期间，8名（17.8%）患者死亡，其中5名患有补体耗竭。补体耗竭的总发生率为64.4%。入院时，平均补体C3和C4水平分别为0.70和0.13 mg/mL。采用ROC曲线预测死亡率，C3的曲线下面积为0.926（95%CI，0.845-0.998，P<0.001），最佳临界值为0.578 mg/mL。补体C3耗竭与严重程度评分无关，但与D-二聚体、PCT浓度升高和术后并发症增加密切相关。补体C3耗竭被发现与严重腹腔脓毒症的不良预后有关。这种消耗似乎与脓毒症时的凝血功能障碍和感染加重有关，在重症监护中应密切关注。ClinicalTrials.gov www.example.com
The complement depletion commonly occurred during sepsis, but it was often underestimated compared with severe infection or coagulation dysfunction. This study was designed to investigate the alteration of complement system in patients with severe abdominal sepsis and evaluate the role of complement depletion in prognosis of such patients. The relationship between complement depletion and infection or coagulopathy was also explored. Forty-five patients with severe abdominal sepsis were prospectively conducted among individuals referral to SICU. Currently recommended treatments, such as early goal-directed resuscitation, source control and antibiotics therapy, were performed. Acute physiology and chronic health evaluation II (APACHE II) and sepsis related organ failure assessment (SOFA) scores were employed to evaluate severity. Plasma levels of C3, C4, CRP, PCT, D-dimer and other parameters were detected within eight times of observation. The 28-day mortality, length of stay, and postoperative complications were compared between complement depletion and non-complement depletion groups. Within the study period, eight (17.8%) patients died, five of them suffering from complement depletion. The overall incidence of complement depletion was 64.4%. At admission, mean complement C3 and C4 levels were 0.70 and 0.13 mg/mL, respectively. Using ROC analysis for mortality prediction, the area under the curve of C3 was 0.926 (95% CI, 0.845–0.998, P<0.001), with optimal cutpoint value of 0.578 mg/mL. Complement C3 depletion was shown to be no correlation to severity scores, however, strongly correlated with elevated D-dimer, PCT concentrations and increased postoperative complications. Complement C3 depletion was found to be connected to poor prognosis in severe abdominal sepsis. This depletion seems to be associated with coagulopathy and aggravated infection during sepsis, which should be paid close attention in critical care. ClinicalTrials.gov NCT01568853
登录
查看更多内容
DOI：
10.2119/molmed.2010.00149
发表时间：
2011-03
期刊：
Molecular medicine (Cambridge, Mass.)
影响因子：
--
作者：
Ehrnthaller C;Ignatius A;Gebhard F;Huber-Lang M
通讯作者：
Huber-Lang M
DOI：
10.4049/jimmunol.0903678
发表时间：
2010-11-01
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
--
作者：
Amara U;Flierl MA;Rittirsch D;Klos A;Chen H;Acker B;Brückner UB;Nilsson B;Gebhard F;Lambris JD;Huber-Lang M
通讯作者：
Huber-Lang M
影响因子：
9
作者：
Oikonomopoulou, Katerina;Ricklin, Daniel;Ward, Peter A.;Lambris, John D.
通讯作者：
Lambris, John D.
影响因子：
6.4
作者：
Leendertse, Masja;Willems, Rob J. L.;van der Poll, Tom
通讯作者：
van der Poll, Tom
影响因子：
3
作者：
CHAPMAN, R;FORAN, R;DUNPHY, JE
通讯作者：
DUNPHY, JE