Presepsin Values Predict Septic Acute Kidney Injury, Acute Respiratory Distress Syndrome, Disseminated Intravascular Coagulation, and Shock
Presepsin Values Predict Septic Acute Kidney Injury, Acute Respiratory Distress Syndrome, Disseminated Intravascular Coagulation, and Shock
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DOI：
10.1097/shk.0000000000001664
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发表时间：
2021-04-01
期刊：
影响因子：
3.1
通讯作者：
Minami, Toshiaki
中科院分区：
文献类型：
--
作者：
Shimoyama, Yuichiro;Umegaki, Osamu;Minami, Toshiaki
背景：脓毒症仍然是危重患者死亡的主要原因。本研究旨在确定前体蛋白是否是脓毒性急性肾损伤（阿基）、急性呼吸窘迫综合征（ARDS）、弥散性血管内凝血（DIC）和休克的预测因子。方法：对83例确诊为脓毒症的成人患者进行前瞻性检查。在入住重症监护室（ICU）后立即和入住ICU后第2、3和5天测量前蛋白酶值。基线时还检查了格拉斯哥预后评分（GPS）、中性粒细胞与淋巴细胞比率、血小板与淋巴细胞比率、预后指数和预后营养指数。对于类别分类，计算总分（下文称为“炎症-前蛋白评分[iPS]”）：如果基线时的前蛋白值和基于炎症的预后评分高于通过28天死亡率的受试者操作特征（ROC）曲线分析确定的截止值，则评分为1;如果它们低于截止值，则评分为0（总分范围，0-2分）。比较了脓毒性阿基、ARDS、DIC或休克患者与无这些疾病患者的前蛋白值、炎症预后评分和iPS。结果如下：ROC曲线分析确定了以下变量作为预测因子：脓毒性阿基第1天和第2天的presepsin;脓毒性ARDS第1天至第3天的presepsin;和iPS-GPS;脓毒性DIC第2天的presepsin和Delta presepsin（第2天至第1天）。多变量分析显示第2天的presepsin是脓毒性DIC的预测因子。结论：Presepsin是脓毒性阿基、ARDS和DIC的预测因子。相对于单独使用基线值，将presepsin值与GPS相结合可提高预测脓毒性ARDS的特异性。
Background: Sepsis remains a major cause of mortality in critically ill patients. This study aimed to determine whether presepsin is a predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and shock. Methods: A total of 83 adult patients diagnosed with sepsis were prospectively examined. Presepsin values were measured immediately after intensive care unit (ICU) admission and on Days 2, 3, and 5 after ICU admission. Glasgow Prognostic Score (GPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, Prognostic Index, and Prognostic Nutritional Index were also examined at baseline. For category classification, total scores were calculated (hereafter, "inflammation-presepsin scores [iPS]") as follows: a score of 1 was assigned if the presepsin value and inflammation-based prognostic scores at baseline were above cutoffs determined by receiver operating characteristic (ROC) curve analysis for 28-day mortality; a score of 0 was assigned if they were below the cutoffs (total score range, 0-2 points). Presepsin values, inflammation-based prognostic scores, and iPS were compared between patients with septic AKI, ARDS, DIC, or shock and those without these disorders. Results: ROC curve analyses identified the following variables as predictors: presepsin on Days 1 and 2 for septic AKI; presepsin on Days 1 to 3; and iPS-GPS for septic ARDS; and presepsin on Day 2 and Delta presepsin (Day 2-Day 1) for septic DIC. Multivariate analysis revealed presepsin on Day 2 to be a predictor of septic DIC. Conclusion: Presepsin is a predictor of septic AKI, ARDS, and DIC. Combining presepsin values with GPS improved the specificity for predicting septic ARDS relative to using baseline presepsin values alone.