Complement component consumption in sepsis correlates better with hemostatic system parameters than with inflammatory biomarkers
Complement component consumption in sepsis correlates better with hemostatic system parameters than with inflammatory biomarkers
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DOI：
10.1016/j.thromres.2018.08.013
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发表时间：
2018-10-01
影响因子：
7.5
通讯作者：
Brkic, Snezana
中科院分区：
文献类型：
--
作者：
Lendak, Dajana;Mihajlovic, Dunja;Brkic, Snezana
引言：本研究的目的是探讨补体C3和C4成分在预测脓毒症结局中的作用。第二个目的是确定补体成分和其他炎症参数之间的关系，和止血参数。方法：一百三十七例脓毒症（脓毒症3标准）被列入本研究。常规实验室标志物、预测性APACHEII和SOFA评分、C3和C4浓度、活化部分凝血活酶时间（aPTT）、凝血酶原时间（PT）、凝血酶时间（TT）、纤维蛋白原、抗凝血酶（AT）、蛋白C（PC）、蛋白S（PS）、内源性凝血酶电位（ETP）、血栓调节蛋白和D-二聚体可用。C3和C4浓度与疾病结局、预测评分、炎症标志物和止血参数相关。结果：死亡组补体水平明显下降（AUCROC（C3）= 0.692，p（C3）< 0.001; AUCROC（C4）= 0.672，p（C4）= 0.001）。C3、C4与APACHEII、SOFA呈显著负相关（C3-APACHEII.=- 0.364，p= 0.011，C3-SOFA。=- 0.460，p < 0.001），aPTT（.=- 0.407，p < 0.001），PT（.=- 0.408，p < 0.001）和D-二聚体（. 0.274，p= 0.001）。观察到与天然抗凝剂（C3-AT.= 0.493，p < 0.001; C3-PC.= 0.450，p < 0.001; C3-PS.= 0.345，p < 0.001）、纤维蛋白原（rho= 0.481，p < 0.001）和ETP（rho= 0.384，p < 0.001）。C3和C4仅与CRP显著相关（rho= 0.207，p= 0.015），而与降钙素原和WBC无显著相关性。结果是相似的C4和C3，虽然C3提出了更高的相关系数。结论：在脓毒症患者的预后较差，观察到一个显着的消耗补体系统。补体成分浓度与凝血参数的相关性强于与炎症生物标志物的相关性。
Introduction: The aim of this study was to investigate the role of C3 and C4 complement components in prediction of sepsis outcome. The secondary aim was to determine relationship between complement components and other inflammatory parameters, and parameters of hemostasis.Methods: One-hundred-thirty-seven patients with sepsis (Sepsis-3 criteria) were included in the study. Routine laboratory markers, predictive APACHEII and SOFA scores, concentrations of C3 and C4, activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time (TT), fibrinogen, antithrombin (AT), protein C (PC), protein S (PS), endogenous thrombin potential (ETP), thrombomodulin, and D-dimer were available. Concentrations of C3 and C4 were correlated with the disease outcome, predictive scores, inflammatory markers and parameters of hemostasis. Statistical analysis was performed using the non-parametric approach and significance was set at p < 0.05.Results: A significant depletion of the complement was observed in non-survivors (AUCROC(C3)= 0.692, p(C3) < 0.001, AUCROC(C4)= 0.672, p(C4)= 0.001). There was a significant negative correlation of C3and C4with APACHEII and SOFA (C3-APACHEII.=-0.364, p= 0.011, C3-SOFA.=-0.460, p < 0.001), aPTT (.=-0.407, p < 0.001), PT (.=-0.408, p < 0.001), and D-dimer (.=-0.274, p= 0.001). A significant positive correlation was observed with natural anticoagulants (C3-AT.= 0.493, p < 0.001; C3-PC.= 0.450, p < 0.001; C3-PS.= 0.345, p < 0.001), fibrinogen (rho= 0.481, p < 0.001), and ETP (rho= 0.384, p < 0.001). C3 and C4 correlated significantly only with CRP (rho= 0.207, p= 0.015), while no significant correlations with procalcitonin and WBC were detected. Results were similar for C4 and C3, although C3 presented higher correlation coefficients.Conclusion: In septic patients with poorer outcome, a significant depletion of the complement system was observed. Concentrations of complement components demonstrated stronger correlations with coagulation parameters than with inflammatory biomarkers.