Sepsis with liver dysfunction and coagulopathy predicts an inflammatory pattern of macrophage activation.
Sepsis with liver dysfunction and coagulopathy predicts an inflammatory pattern of macrophage activation.
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DOI：
10.1186/s40635-022-00433-y
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发表时间：
2022-02-21
影响因子：
3.5
通讯作者：
ProCESS Investigators
中科院分区：
文献类型：
--
作者：
Anderko RR;Gómez H;Canna SW;Shakoory B;Angus DC;Yealy DM;Huang DT;Kellum JA;Carcillo JA;ProCESS Investigators
白细胞介素-1受体拮抗剂可降低伴有肝胆功能障碍和弥散性血管内凝血（HBD + DIC）的脓毒性休克患者的死亡率，这是一种具有与巨噬细胞活化一致的炎症特征的器官衰竭模式。脓毒症临床表型的鉴定可能有助于改善护理。我们的目的是描述HBD + DIC在当代脓毒症患者队列中的发生情况，并确定该表型与已知的巨噬细胞活化综合征（MAS）生物标志物和死亡率的相关性。我们对合并HBD + DIC的成人感染性休克患者和相同数量的年龄匹配对照进行了一项回顾性巢式病例对照研究，并对两组之间的全因死亡率和循环生物标志物进行了比较分析。多元Logistic回归分析探讨了HBD + DIC对死亡率的影响以及HBD + DIC和死亡率的生物标志物的鉴别能力。6%的感染性休克患者（n = 82/1341）患有HBD + DIC，这是90天死亡率的独立风险因素（OR = 3.1，95% CI 1.4-7.5，p = 0.008）。相对于脓毒症对照，HBD + DIC组群具有与巨噬细胞活化相关的26种生物标志物中的21种的增加的水平（p < 0.05）。这一组预测HBD + DIC（敏感性= 82%，特异性= 84%）和死亡率（敏感性= 92%，特异性= 90%）。HBD + DIC表型鉴定出具有高死亡率和类似MAS的分子特征的患者。这些观察结果表明，MAS导向治疗的试验是必要的。在线版本包含补充材料，可通过10.1186/s40635-022-00433-y获得。
Interleukin-1 receptor antagonists can reduce mortality in septic shock patients with hepatobiliary dysfunction and disseminated intravascular coagulation (HBD + DIC), an organ failure pattern with inflammatory features consistent with macrophage activation. Identification of clinical phenotypes in sepsis may allow for improved care. We aim to describe the occurrence of HBD + DIC in a contemporary cohort of patients with sepsis and determine the association of this phenotype with known macrophage activation syndrome (MAS) biomarkers and mortality. We performed a retrospective nested case–control study in adult septic shock patients with concurrent HBD + DIC and an equal number of age-matched controls, with comparative analyses of all-cause mortality and circulating biomarkers between the groups. Multiple logistic regression explored the effect of HBD + DIC on mortality and the discriminatory power of the measured biomarkers for HBD + DIC and mortality. Six percent of septic shock patients (n = 82/1341) had HBD + DIC, which was an independent risk factor for 90-day mortality (OR = 3.1, 95% CI 1.4–7.5, p = 0.008). Relative to sepsis controls, the HBD + DIC cohort had increased levels of 21 of the 26 biomarkers related to macrophage activation (p < 0.05). This panel was predictive of both HBD + DIC (sensitivity = 82%, specificity = 84%) and mortality (sensitivity = 92%, specificity = 90%). The HBD + DIC phenotype identified patients with high mortality and a molecular signature resembling that of MAS. These observations suggest trials of MAS-directed therapies are warranted. The online version contains supplementary material available at 10.1186/s40635-022-00433-y.
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影响因子：
27.4
作者：
Gabay C;Fautrel B;Rech J;Spertini F;Feist E;Kötter I;Hachulla E;Morel J;Schaeverbeke T;Hamidou MA;Martin T;Hellmich B;Lamprecht P;Schulze-Koops H;Courvoisier DS;Sleight A;Schiffrin EJ
通讯作者：
Schiffrin EJ
影响因子：
13.3
作者：
Fardet, Laurence;Galicier, Lionel;Hejblum, Gilles
通讯作者：
Hejblum, Gilles
影响因子：
6.5
作者：
AKASHI, K;HAYASHI, S;NIHO, Y
通讯作者：
NIHO, Y
DOI：
10.1016/s0889-8588(05)70521-9
发表时间：
1998-04-01
影响因子：
2.4
作者：
Janka, G;Imashuku, S;Henter, JI
通讯作者：
Henter, JI
影响因子：
3.3
作者：
Gómez H;Kellum JA
通讯作者：
Kellum JA