Presepsin as a predictor of critical colonization in CLI hemodialysis patients
Presepsin as a predictor of critical colonization in CLI hemodialysis patients
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Presepsin 作为 CLI 血液透析患者关键定植的预测因子
DOI：
10.1111/wrr.12371
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发表时间：
2016
影响因子：
2.9
通讯作者：
Jun Shiota; Norihiko Ohura; Shingo Higashikawa; Tsunee Yamato; Hitoshi Kasahara; Keiichi Itatani; Hitoshi Tagawa
中科院分区：
文献类型：
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作者：
Kakizaki R;Nabeta T;Ishii S;Koitabashi T;Itatani K;Inomata T;Ako J.;Satoshi Numata; Keiichi Itatani; Keiichi Kanda; Kiyoshi Doi; Sachiko Yamazaki; Kazuki Morimoto; Kaichiro Manabe; Koki Ikemoto; Hitoshi Yaku;Norihiko Oka; Takamichi Inoue; Miyuki Shibata; Takeshi Yoshii; Yuki Nakamura; Haruna Araki; Yoshikiyo Matsunaga; Tomoki Tamura; Keiichi Itatani; Tetsuya Horai; Tadashi Kitamura; Shinzo Torii; Kagami Miyaji;Jun Shiota; Norihiko Ohura; Shingo Higashikawa; Tsunee Yamato; Hitoshi Kasahara; Keiichi Itatani; Hitoshi Tagawa
严重肢体缺血（CLI）期间的感染是一个具有挑战性的问题。血浆前蛋白是一种新的感染生物标志物，与巨噬细胞的吞噬作用有关。本研究的目的是探讨前体蛋白作为感染性CLI早期检测的指标和预测因子的有效性。在20名接受血液透析（HD）的CLI患者（Rutherford 5和6）中进行了一项回顾性观察性研究。分析了20例接受HD治疗的CLI患者（平均年龄70.7 ± 5.6岁，男性85%）和15例接受HD治疗但无CLI和感染的健康患者（对照组）。所有CLI患者均接受了适当的血运重建和整形外科治疗。将CLI患者分为两组：愈合组，上皮完全形成，无分泌物;不愈合组，有感染体征。采用PATHFAST全自动免疫分析仪，基于非竞争性荧光酶免疫分析法，测定并比较两组和对照组的血浆前蛋白。对照组的中位血浆前体素及其四分位数范围为1，320（1，055 - 1，465）pg/mL，愈合组为1，320（1，050 - 1，613）pg/mL，未愈合组为3，193（2，519 - 3，832）pg/mL。未愈合组血浆前蛋白浓度显著高于对照组（P< 0.001）和愈合组（P< 0.01）。受试者工作特征曲线分析显示，在各种炎症标志物中，包括C反应蛋白和白色血细胞计数，前蛋白的准确性最高（0.979）。诊断临界值为2，083 pg/mL，能够区分未愈合组和愈合组，敏感性为100%，特异性为88.9%。我们的研究结果表明，血浆presepsin可能是有用的预测“临界定植”和“感染”在不愈合的CLI在HD患者，因此，明确的临界值可用于确定再干预和/或主要截肢的适应症。
Infection during critical limb ischemia (CLI) is a challenging issue. Plasma presepsin is a novel biomarker for infection, which is related to bacterial phagocytosis by macrophages. The purpose of this study was to investigate the validity of presepsin as an indicator and predictor for early detection of infectious CLI. A retrospective observational study was conducted among 20 CLI patients (Rutherford 5 and 6) on hemodialysis (HD). Twenty CLI patients on HD (mean age 70.7 ± 5.6 years, male 85%) and 15 healthy patients on HD without CLI and infection (control group) were analyzed. All CLI patients received appropriate revascularization and plastic surgical treatment. CLI patients were classified into two groups: the healing group with complete epithelialization without discharge and the nonhealing group with infection signs. Plasma presepsin was measured and compared among the two groups and the control group using an automated immunoanalyzer, PATHFAST, based on a noncompetitive chemiluminescent enzyme immunoassay. The median plasma presepsin and its interquartile range were 1,320 (1,055–1,465) pg/mL in the control group, 1,320 (1,050–1,613) pg/mL in the healing group and 3,193 (2,519–3,832) pg/mL in the nonhealing group. The plasma presepsin concentrations were significantly higher in the nonhealing group compared with the control group (p< 0.001) and the healing group (p< 0.01). A receiver operating characteristic curve analysis revealed that presepsin had highest accuracy (0.979) among various inflammatory markers, including C‐reactive protein and the white blood cell count. The diagnostic cutoff value of 2,083 pg/mL was able to distinguish the nonhealing group and healing group with a sensitivity of 100% and a specificity of 88.9%. Our results suggest that plasma presepsin may be useful for predicting “critical colonization” and “infection” in nonhealing CLI in HD patients, therefore, the definitive cutoff value may be used for determinating the indication for reintervention and/or major limb amputation.