A high angiopoietin-2/angiopoietin-1 ratio is associated with a high risk of septic shock in patients with febrile neutropenia.
A high angiopoietin-2/angiopoietin-1 ratio is associated with a high risk of septic shock in patients with febrile neutropenia.
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DOI：
10.1186/cc12848
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发表时间：
2013-08-05
期刊：
影响因子：
--
通讯作者：
De Paula EV
中科院分区：
文献类型：
--
作者：
Luz Fiusa MM;Costa-Lima C;de Souza GR;Vigorito AC;Penteado Aranha FJ;Lorand-Metze I;Annichino-Bizzacchi JM;de Souza CA;De Paula EV
内皮屏障破坏是感染性休克的标志，生理调节内皮屏障完整性的蛋白质正在成为感染性休克发展的有希望的生物标志物。患有癌症和发热性中性粒细胞减少症（FN）的患者出现脓毒症并发症（如脓毒性休克）的风险较高。尽管如此，这些患者通常在脓毒症生物标志物研究中被排除或代表性不足。我们研究的目的是验证一组微血管通透性调节剂作为化疗相关FN癌症患者感染性休克发展的生物标志物的测量。这是一项诊断准确性的前瞻性研究，在一所大学医院的两个不同的住院单位进行。根据我们当地的实践，在模拟脓毒症生物标志物的真实使用的条件下，在血小板减少性发热发作后测量血管内皮生长因子A（VEGF-A）、可溶性fms样酪氨酸激酶-1（sFlt-1）和血管生成素（Ang）1和2的水平。根据28天内发生败血性休克的结局对患者进行分类。在该研究中，共对99例连续患者进行了评价，其中20例发生了脓毒性休克，79例被归类为非复杂性FN。两个结局组之间的VEGF-A和sFlt-1水平相似。相比之下，脓毒性休克患者中Ang-2浓度升高，而Ang-1则相反，脓毒性休克患者中Ang-2/Ang-1比值（5.29，范围0.58 - 57.14）高于非并发FN患者（1.99，范围0.06 - 64.62; P = 0.01）。多变量分析后，Ang-2/Ang-1比值仍然是脓毒性休克发展和28天死亡率的独立因素。高Ang-2/Ang-1比值可预测伴有发热性中性粒细胞减少症的癌症患者发生败血性休克。
Endothelial barrier breakdown is a hallmark of septic shock, and proteins that physiologically regulate endothelial barrier integrity are emerging as promising biomarkers of septic shock development. Patients with cancer and febrile neutropenia (FN) present a higher risk of sepsis complications, such as septic shock. Nonetheless, these patients are normally excluded or under-represented in sepsis biomarker studies. The aim of our study was to validate the measurement of a panel of microvascular permeability modulators as biomarkers of septic shock development in cancer patients with chemotherapy-associated FN. This was a prospective study of diagnostic accuracy, performed in two distinct in-patient units of a university hospital. Levels of vascular endothelial growth factor A (VEGF-A), soluble fms-like tyrosine kinase-1 (sFlt-1) and angiopoietin (Ang) 1 and 2 were measured after the onset of neutropenic fever, in conditions designed to mimic the real-world use of a sepsis biomarker, based on our local practice. Patients were categorized based on the development of septic shock by 28 days as an outcome. A total of 99 consecutive patients were evaluated in the study, of which 20 developed septic shock and 79 were classified as non-complicated FN. VEGF-A and sFlt-1 levels were similar between both outcome groups. In contrast, Ang-2 concentrations were increased in patients with septic shock, whereas an inverse finding was observed for Ang-1, resulting in a higher Ang-2/Ang-1 ratio in patients with septic shock (5.29, range 0.58 to 57.14) compared to non-complicated FN (1.99, range 0.06 to 64.62; P = 0.01). After multivariate analysis, the Ang-2/Ang-1 ratio remained an independent factor for septic shock development and 28-day mortality. A high Ang-2/Ang-1 ratio can predict the development of septic shock in cancer patients with febrile neutropenia.
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影响因子：
15.1
作者：
Kuempers, Philipp;Gueler, Faikah;Shushakova, Nelli
通讯作者：
Shushakova, Nelli
影响因子：
45.3
作者：
Klastersky, J;Paesmans, M;Talcott, J
通讯作者：
Talcott, J
影响因子：
2.6
作者：
Guo, Baoping;Liu, Yan;Cen, Hong
通讯作者：
Cen, Hong
影响因子：
3.1
作者：
Hamalainen, Sari;Juutilainen, Auni;Jantunen, Esa
通讯作者：
Jantunen, Esa
DOI：
10.1186/cc7866
发表时间：
2009
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kümpers P;van Meurs M;David S;Molema G;Bijzet J;Lukasz A;Biertz F;Haller H;Zijlstra JG
通讯作者：
Zijlstra JG