A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis
A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis
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DOI：
10.1097/ccm.0b013e318192fd9d
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发表时间：
2009-01-01
影响因子：
8.8
通讯作者：
Rivers, Emanuel P.
中科院分区：
文献类型：
--
作者：
Shapiro, Nathan I.;Trzeciak, Stephen;Rivers, Emanuel P.
目的：定义一个生物标志物组来预测疑似败血症的急诊科（ED）患者的器官功能障碍、休克和住院死亡率。设计：前瞻性观察研究。环境：十个学术医疗中心的急诊科。患者：共纳入971例患者。纳入标准：1)年龄在bb0 ~ 18岁的ED患者；2)疑似感染或血清乳酸水平> 2.5 mmol/L；3)两项或两项以上全身性炎症反应综合征标准。排除标准：妊娠、无复苏状态或心脏骤停。测量和主要结果：从ED表现时获得的血液中检测了9种生物标志物。使用多变量逻辑回归来确定生物标志物的最佳组合以创建面板。加权生物标志物值的导出公式用于计算“脓毒症评分”，这是72小时内严重脓毒症（脓毒症加器官功能障碍）主要结局的预测概率。我们还评估了脓毒症评分预测72小时内脓毒症休克的次要结局指标和住院死亡率的能力。各结局的总发生率为：严重脓毒症，52%；感染性休克，39%；住院死亡率为7%在测试的9个生物标志物中，最佳的3个标记组是中性粒细胞明胶酶相关的脂钙蛋白、蛋白C和白细胞介素-1受体拮抗剂。由这三种生物标志物得出的脓毒症评分准确性曲线下面积为：严重脓毒症为0.80，感染性休克为0.77，死亡为0.79。当纳入具有临床变量的多变量模型时，脓毒症评分在所有三种结果中仍然非常显著（p < 0.001）。结论：中性粒细胞明胶酶相关脂钙蛋白、白细胞介素-1ra和蛋白C的生物标志物可预测疑似脓毒症的ED患者的严重脓毒症、脓毒症休克和死亡。需要进一步的研究来前瞻性地验证这些生物标志物和脓毒症评分在疑似脓毒症风险分层患者中的临床应用。（重症护理医学2009；37:96-104）
Objective: To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis.Design: Prospective observational study.Setting: EDs of ten academic medical centers.Patients: There were 971 patients enrolled. Inclusion criteria: 1) ED patients age > 18; 2) suspected infection or a serum lactate level > 2.5 mmol/L; and 3) two or more systemic inflammatory response syndrome criteria. Exclusion criteria: pregnancy, donot-resuscitate status, or cardiac arrest.Measurements and Main Results: Nine biomarkers were assayed from blood draws obtained on ED presentation. Multivark able logistic regression was used to identity an optimal combination of biomarkers to create a panel. The derived formula for weighting biomarker values was used to calculate a "sepsis score," which was the predicted probability of the primary outcome of severe sepsis (sepsis plus organ dysfunction) within 72 hrs. We also assessed the ability of the sepsis score to predict secondary outcome measures of septic shock within 72 hrs and in-hospital mortality. The overall rates of each outcome were severe sepsis, 52%; septic shock, 39%; and in-hospital mortality 7%. Among the nine biomarkers tested, the optimal 3-marker panel was neutrophil gelatinase-associated lipocalin, protein C, and interleukin-1 receptor antagonist. The area under the curve for the accuracy of the sepsis score derived from these three biomarkers was 0.80 for severe sepsis, 0.77 for septic shock, and 0.79 for death. When included in multivariate models with clinical variables, the sepsis score remained highly significant (p < 0.001) for all the three outcomes.Conclusions: A biomarker panel of neutrophil gelatinase-associated lipocalin, interleukin-1ra, and Protein C was predictive of severe sepsis, septic shock, and death in ED patients with suspected sepsis. Further study is warranted to prospectively validate the clinical utility of these biomarkers and the sepsis score in risk-stratifying patients with suspected sepsis. (Crit Care Med 2009; 37:96-104)