Response to A Letter to the Editor: In Septic ICU Patients, Presepsin is A Predictor of AKI, ARDS, and DIC - Renal Replacement Therapy Initiation only has A Minor Impact on The Results of The Present Study
Response to A Letter to the Editor: In Septic ICU Patients, Presepsin is A Predictor of AKI, ARDS, and DIC - Renal Replacement Therapy Initiation only has A Minor Impact on The Results of The Present Study
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对致编辑的一封信的回应：在脓毒症 ICU 患者中，Presepsin 是 AKI、ARDS 和 DIC 的预测因子 - 肾脏替代治疗的启动仅对本研究的结果产生较小影响
DOI：
10.1097/shk.0000000000001801
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发表时间：
2021
期刊：
影响因子：
3.1
通讯作者：
Minami Toshiaki
中科院分区：
文献类型：
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作者：
Shimoyama Yuichiro;Umegaki Osamu;Kadono Noriko;Minami Toshiaki
编者：我们怀着极大的兴趣阅读了Shimoyama等人最近发表的论文。(1)他们在对重症监护病房（ICU）患者的研究中得出结论，前体蛋白是脓毒性急性肾损伤（阿基）、急性呼吸窘迫综合征（ARDS）和弥散性血管内凝血病（DIC）的预测因子。相对于单独使用基础值，结合前蛋白值和格拉斯哥预后评分可提高预测脓毒性ARDS的特异性（1）。阿基的发生率为38/83（1），脓毒性休克的发生率为48/83（1）。研究中未提及肾脏替代治疗（RRT）的发生率（1）。近一半的重症患者患有或发展为阿基，超过20%的患者在重症监护住院的第一周内需要RRT（2）。本研究中RRT的发生率应该没有很大差异，因为它们包括ICU中阿基和脓毒性休克比例较高的患者（1）。Presepsin的分子量为13，000道尔顿（Da）（3）。当代连续RRT（CRRT）膜能够清除高达35，000 Da的分子（3）。因此，CRRT可通过对流轻松清除前蛋白（3）。当使用具有高吸收能力的新型高吸附性膜时，CRRT消除前蛋白的能力甚至可以通过吸附来增强（4）。在这项研究中，前体素的增加与阿基、ARDS和DIC相关（1）。如果在这些患者中观察到假性低的前体素浓度，则可能导致更早的治疗降级。研究结果可能因这一混杂因素而无效，这是理所当然的。尚未对接受CRRT的患者使用presepsin的性能进行研究。因此，我们认为未来迫切需要开展一项研究，重点关注目前已知的脓毒症生物标志物在接受CRRT患者中的表现（5）。
To the Editor: We have read with great interest the recently published paper by Shimoyama et al.(1) who conclude in their study in intensive care unit (ICU) patients that presepsin is a predictor of septic acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and disseminated intravascular coagulopathy (DIC). Combining presepsin values with Glasgow Prognostic Score improved the specificity for predicting septic ARDS relative to using baseline presepsin values alone (1). The incidence of AKI was mentioned at 38 out of 83 (1) and the incidence of septic shock was 48 out of 83 (1). The incidence of renal replacement therapy (RRT) in the study was not mentioned (1). Nearly half of critically ill patients have or develop AKI and more than 20% need RRT within the first week of their intensive care stay (2). The incidence of RRT in this study should be not very different as they included patients in the ICU with a high percentage of AKI and septic shock (1). Presepsin has a molecular weight of a 13,000 Daltons (Da)(3). The contemporary continuous RRT (CRRT) membranes are able to remove molecules as large as 35,000 Da (3). Hence, presepsin could easily be removed by CRRT through convection (3). When new highly adsorptive membranes with high absorptive abilities are used, the ability of CRRT to eliminate presepsin could even be enhanced through adsorption (4). In the study, increase of presepsin was correlated with AKI, ARDS, and DIC (1). If falsely low presepsin concentration was seen in these patients, could lead in turn to an earlier de-escalation of therapy. It stands to reason that the results of the study could be invalidated by this confounding factor. There has been no investigation on the performance of presepsin on patients who receive CRRT. Therefore, we believe there is a critical need for a future study with a focus on the performance of the currently known sepsis biomarkers among those who receive CRRT (5).