Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
Blood lactate/ATP ratio, as an alarm index and real-time biomarker in critical illness.
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DOI：
10.1371/journal.pone.0060561
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Kido H
中科院分区：
文献类型：
--
作者：
Chida J;Ono R;Yamane K;Hiyoshi M;Nishimura M;Onodera M;Nakataki E;Shichijo K;Matushita M;Kido H
急性生理学、年龄和慢性健康评估(APACHE)II评分和其他相关评分已被用于评估重症监护病房(ICU)的疾病严重性，但仍需要实时和灵敏的预后生物标志物。最近，来自受损组织的警示分子被报道为警报信号分子。虽然ATP是警报中的一员，其在组织中的耗竭与多器官衰竭密切相关，但血液中的ATP水平尚未在危重疾病中得到评估。为了确定危重病的实时预后生物标志物，我们测量了危重病患者的血三磷酸腺苷水平和乳酸/三磷酸腺苷比率(三磷酸腺苷-乳酸能量风险评分，A-LES)。连续采集了42名重症ICU患者和155名健康受试者的血液样本。用APACHE II评分比较血ATP水平和A-LES对预后的影响。健康受试者的平均三磷酸腺苷水平(SD)为0.62(0.19)mm，无明显的年龄和性别差异。重症患者入院时三磷酸腺苷水平的中位数为0.31 mm(四分位数范围为0.25~0.44)，显著低于中度患者的0.56 mm(0.38~0.70)(P<；0.01)。用三磷酸腺苷进行的评估被乳酸进一步修正，并表示为A-LES。出院时预后满意的患者的A-LES中位数为2.7(2.1~3.3)，而死亡患者的A-LES中位数为38.9(21.0~67.9)，差异有统计学意义(P<；0.01)。受试者操作特征分析表明，在ICU入院时测定血ATP和A-LES与APACHE II评分对预测死亡率同样有用。血中三磷酸腺苷水平和A-LES是ICU入院时预测死亡率的敏感生物标志物。此外，A-LES还提供了ICU期间病情严重程度的进一步实时评估评分，特别是对于APACHE II评分为≥20.0的危重患者。
The acute physiology, age and chronic health evaluation (APACHE) II score and other related scores have been used for evaluation of illness severity in the intensive care unit (ICU), but there is still a need for real-time and sensitive prognostic biomarkers. Recently, alarmins from damaged tissues have been reported as alarm-signaling molecules. Although ATP is a member of the alarmins and its depletion in tissues closely correlates with multiple-organ failure, blood ATP level has not been evaluated in critical illness. To identify real-time prognostic biomarker of critical illness, we measured blood ATP levels and the lactate/ATP ratio (ATP-lactate energy risk score, A-LES) in critically ill patients. Blood samples were collected from 42 consecutive critically ill ICU patients and 155 healthy subjects. The prognostic values of blood ATP levels and A-LES were compared with APACHE II score. The mean ATP level (SD) in healthy subjects was 0.62 (0.19) mM with no significant age or gender differences. The median ATP level in severely ill patients at ICU admission was significantly low at 0.31 mM (interquartile range 0.25 to 0.44) than the level in moderately ill patient at 0.56 mM (0.38 to 0.70) (P<0.01). Assessment with ATP was further corrected by lactate and expressed as A-LES. The median A-LES was 2.7 (2.1 to 3.3) in patients with satisfactory outcome at discharge but was significantly higher in non-survivors at 38.9 (21.0 to 67.9) (P<0.01). Receiver operating characteristic analysis indicated that measurement of blood ATP and A-LES at ICU admission are as useful as APACHE II score for prediction of mortality. Blood ATP levels and A-LES are sensitive prognostic biomarkers of mortality at ICU admission. In addition, A-LES provided further real-time evaluation score of illness severity during ICU stay particularly for critically ill patients with APACHE II scores of ≥20.0.
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影响因子：
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作者：
Ellsworth, Mary L.;Ellis, Christopher G.;Goldman, Daniel;Stephenson, Alan H.;Dietrich, Hans H.;Sprague, Randy S.
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