Diagnostic and prognostic utility of tissue factor for severe sepsis and sepsis-induced acute lung injury.
Diagnostic and prognostic utility of tissue factor for severe sepsis and sepsis-induced acute lung injury.
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组织因子对严重脓毒症和脓毒症引起的急性肺损伤的诊断和预后效用
DOI：
10.1186/s12967-015-0518-9
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发表时间：
2015-05-30
影响因子：
7.4
通讯作者：
Song Z
中科院分区：
文献类型：
--
作者：
Xue M;Sun Z;Shao M;Yin J;Deng Z;Zhang J;Xing L;Yang X;Chen B;Dong Z;Han Y;Sun S;Wang Y;Yao C;Chu X;Tong C;Song Z
组织因子（TF）和组织因子途径抑制剂（TFPI）在内皮通透性调节和功能障碍中发挥核心作用，这与脓毒症和急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的发生有关。本研究的目的是评估 TF 和 TFPI 对脓毒症和脓毒症引起的 ARDS 患者的诊断和预后价值。共有 62 名脓毒症患者、167 名严重脓毒症患者和 32 名健康志愿者参加了这项前瞻性观察研究。通过酶联免疫吸附测定（ELISA）测量 TF 和 TFPI 水平。脓毒症诱发的ARDS患者的TF中位水平显着高于无ARDS患者（1425.5（1019.9至2595.2）pg/ml vs 916.2（724.1至1618.2）pg/ml，P < 0.001），并且与脓毒症患者相比（943.5（786.4至992.4）） pg/ml，P < 0.001）入院当天。然而，脓毒症患者与健康受试者、脓毒症休克患者与非脓毒症休克患者之间无显着性差异（P > 0.05）。 TF 诊断脓毒症引起的 ARDS 的 AUC 为 0.749（95% 置信区间 (CI) 0.675-0.822）。严重脓毒症非幸存者的血浆TF水平显着高于幸存者（1618.6（1017.1至2900.8）pg/ml vs. 979.9（757.2至1645.5）pg/ml，P < 0.001），多变量logistic回归显示血浆TF值是独立预测因素严重脓毒症患者的 30 天死亡率（P = 0.0022，比值比 (OR) = 1.41，95% CI 1.24-1.69）。 TF 预测严重脓毒症患者 30 天死亡率的 AUC 为 0.718 (95% CI 0.641-0.794)。而健康对照组、脓毒症组和严重脓毒症组血浆TFPI值差异无统计学意义（P > 0.05）。我们的数据表明，组织因子是诊断脓毒症引起的 ARDS 的有价值的诊断生物标志物。此外，组织因子是严重脓毒症和脓毒症诱发的 ARDS 患者短期死亡率的强有力的预后标志物。
Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) play a central role in the endothelial permeability regulation and dysfunction, which is associated with the development of sepsis and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The aim of this study is to assess the diagnostic and prognostic values of TF and TFPI in patients with sepsis and sepsis-induced ARDS. A total of 62 patients with sepsis, 167 patients with severe sepsis and 32 healthy volunteers were enrolled in this prospective observational study. TF and TFPI levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients with sepsis-induced ARDS showed significantly higher median levels of TF compared with patients without ARDS (1425.5 (1019.9 to 2595.2) pg/ml vs 916.2 (724.1 to 1618.2) pg/ml, P < 0.001), and compared with sepsis patients (943.5 (786.4 to 992.4) pg/ml, P < 0.001) on the day of admission. However, there was no significant difference between sepsis patients and healthy subjects, or between septic shock and non-septic shock patients (P > 0.05). The AUC of TF for the diagnosis of sepsis-induced ARDS was 0.749 (95% confidence interval (CI) 0.675-0.822). Plasma TF levels in the non-survivors of severe sepsis were significantly higher than those of survivors (1618.6 (1017.1 to 2900.8) pg/ml vs. 979.9 (757.2 to 1645.5) pg/ml, P < 0.001), and multivariate logistic regression showed the plasma value of TF was the independent predictor for 30-day mortality in patients with severe sepsis (P = 0.0022, odds ratio (OR) = 1.41, 95% CI 1.24-1.69). The AUC of TF for predicting 30-day mortality in severe sepsis patients was 0.718 (95% CI 0.641-0.794). However, there was no significant difference in the plasma TFPI values among the healthy control, sepsis and severe sepsis groups (P > 0.05). Our data showed that tissue factor is a valuable diagnostic biomarker for the diagnosis of sepsis-induced ARDS. Moreover, tissue factor is a strong prognostic marker for short-term mortality in severe sepsis and sepsis-induced ARDS patients.
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