Multi-biomarker strategy for prediction of myocardial dysfunction and mortality in sepsis
Multi-biomarker strategy for prediction of myocardial dysfunction and mortality in sepsis
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预测脓毒症心肌功能障碍和死亡率的多生物标志物策略
DOI：
10.1631/jzus.b2000049
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发表时间：
2020-07-01
影响因子：
5.1
通讯作者：
Zhang, Zhao-cai
中科院分区：
文献类型：
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作者：
Chen, Fa-chao;Xu, Yin-chuan;Zhang, Zhao-cai
本研究旨在评价多生物标志物策略预测脓毒症患者脓毒症诱导的心肌功能障碍（SIMD）和死亡率的可行性。对147例脓毒症患者在入院后6 h内测定脑钠肽（BNP）、心肌肌钙蛋白I（cTnI）和心脏型脂肪酸结合蛋白（h-FABP）。我们还测定了血浆髓过氧化物酶（MPO）和妊娠相关血浆蛋白-A（PAPP-A）的水平。采用受试者工作特征曲线（ROC）评价各种单一生物标志物诊断SIMD和预测死亡率的最佳截止值。此外，ROC曲线，净重新分类改善（NRI），综合辨别改善（IDI）指数被用来评估使用多个生物标志物预测SIMD和死亡率的可行性。我们的统计显示只有h-FABP能独立预测SIMD（P<0.05）。将MPO和cTnI加入h-FABP中进行SIMD预测，NRI为18.7%（P=0.025），IDI为3.3%（P=0.033）。而在h-FABP中加入MPO或cTnI并不能显著提高h-FABP对SIMD的预测能力，曲线下面积（AUC）、NRI和IDI均表明这一点（P均>0.05）。有无休克史和MPO是脓毒症患者死亡的独立预测因素（均P<0.05）。在MPO中加入PAPP-A和h-FABP导致NRI为25.5%（P=0.013）和IDI为2.9%（P=0.045）的死亡率预测。然而，这项研究显示，在MPO中加入h-FABP或PAPP-A并没有显著提高预测死亡率的能力，如AUC，NRI和IDI所证明的（均P>0.05）。本研究的结果表明，一个敏感和特异性的战略，早期诊断SIMD和死亡率预测脓毒症应包括三个生物标志物。
The present study was to evaluate the feasibility of using the multi-biomarker strategy for the prediction of sepsis-induced myocardial dysfunction (SIMD) and mortality in septic patients. Brain natriuretic peptide (BNP), cardiac troponin I (cTnI), and heart-type fatty acid-binding protein (h-FABP) in 147 septic patients were assayed within 6 h after admission. We also determined the plasma levels of myeloperoxidase (MPO) and pregnancy-associated plasma protein-A (PAPP-A). The receiver operating characteristic (ROC) curve was used to assess the best cutoff values of various single-biomarkers for the diagnosis of SIMD and the prediction of mortality. Also, the ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) indices were used to evaluate the feasibility of using multi-biomarkers to predict SIMD and mortality. Our statistics revealed that only h-FABP independently predicted SIMD (P<0.05). The addition of MPO and cTnI to h-FABP for SIMD prediction provided an NRI of 18.7% (P=0.025) and IDI of 3.3% (P=0.033). However, the addition of MPO or cTnI to h-FABP did not significantly improve the predictive ability of h-FABP to SIMD, as evidenced by the area under the curve (AUC), NRI, and IDI (all P>0.05). A history of shock and MPO were independent predictors of mortality in septic patients (both P<0.05). The addition of PAPP-A and h-FABP to MPO resulted in a mortality prediction with NRI of 25.5% (P=0.013) and IDI of 2.9% (P=0.045). However, this study revealed that the addition of h-FABP or PAPP-A to MPO did not significantly improve the ability to predict mortality, as evidenced by the AUC, NRI, and IDI (all P>0.05). The findings of this study indicate that a sensitive and specific strategy for early diagnosis of SIMD and mortality prediction in sepsis should incorporate three biomarkers.