Circulating angiopopietin-1 correlates with the clinical course of multiple organ dysfunction syndrome and mortality in patients with severe sepsis.
Circulating angiopopietin-1 correlates with the clinical course of multiple organ dysfunction syndrome and mortality in patients with severe sepsis.
复制标题
DOI：
10.1097/md.0000000000000878
复制
发表时间：
2015-05
期刊：
影响因子：
1.6
通讯作者：
Kuo HP
中科院分区：
文献类型：
--
作者：
Lin SM;Chung FT;Kuo CH;Chou PC;Wang TY;Chang PJ;Lo YL;Huang CD;Lin HC;Wang CH;Kuo HP
测定脓毒症诱导的多器官功能障碍综合征（MODS）患者中血管生成素（Ang）-1、Ang -2、Tie -2和血管内皮生长因子（VEGF）的血浆浓度，并确定它们与死亡率的关联。
该研究前瞻性地招募了一家三级医院重症监护病房的96例连续的严重脓毒症患者。在脓毒症第1、3和7天测定患者的血浆Ang -1、Ang -2、Tie -2和VEGF水平以及MODS情况。进行单变量和Cox比例风险分析以建立一个预后模型。
MODS患者在第1、3和7天的血浆Ang -1浓度持续低于非MODS患者（第1天：4.0 ± 0.5对8.0 ± 0.5 ng/mL，P < 0.0001；第3天，3.2 ± 0.6对7.3 ± 0.5 ng/mL，P < 0.0001；第7天，2.8 ± 0.6对10.4 ± 0.7 ng/mL，P < 0.0001）。在脓毒症第7天MODS缓解的患者中，Ang -1水平从第1天开始升高（4.7 ± 0.6 ng/mL对9.1 ± 1.4 ng/mL，n = 43，P = 0.004）。在严重脓毒症第1天（4.0 ± 0.5对7.1 ± 0.5 ng/mL，P < 0.0001）、第3天（3.8 ± 0.6对7.1 ± 0.5 ng/mL，P < 0.0001）和第7天（4.7 ± 0.7对11.0 ± 0.8 ng/mL，P < 0.0001），未存活者的血浆Ang -1水平低于存活者。相反，仅在第1天未存活者的血浆Ang -2水平高于存活者（15.8 ± 2.0对9.5 ± 1.2 ng/mL，P = 0.035）。VEGF和Tie -2水平与MODS和死亡率无关。Ang -1水平低于中位数是死亡率的唯一独立预测因子（风险比，2.57；95%置信区间1.12 - 5.90，P = 0.025）。
Ang -1水平持续降低与脓毒症患者的MODS以及随后的死亡率相关。
To determine plasma concentrations of angiopoietin (Ang)-1, Ang-2, Tie-2, and vascular endothelial growth factor (VEGF) in patients with sepsis-induced multiple organ dysfunction syndrome (MODS) and determine their association with mortality. The study prospectively recruited 96 consecutive patients with severe sepsis in a l intensive care unit of a tertiary hospital. Plasma Ang-1, Ang-2, Tie-2, and VEGF levels and MODS were determined in patients on days 1, 3, and 7 of sepsis. Univariate and Cox proportional hazards analysis were performed to develop a prognostic model. Days 1, 3, and 7 plasma Ang-1 concentrations were persistently decreased in MODS patients than in non-MODS patients (day1: 4.0 ± 0.5 vs 8.0 ± 0.5 ng/mL, P < 0.0001; day 3, 3.2 ± 0.6 vs 7.3 ± 0.5 ng/mL, P < 0.0001, day 7, 2.8 ± 0.6 vs 10.4 ± 0.7 ng/mL, P < 0.0001). In patients with resolved MODS on day 7 of sepsis, Ang-1 levels were increased from day 1 (4.7 ± 0.6 ng/mL vs 9.1 ± 1.4 ng/mL, n = 43, P = 0.004). Plasma Ang-1 levels were lower in nonsurvivors than in survivors on days 1 (4.0 ± 0.5 vs 7.1 ± 0.5 ng/mL, P < 0.0001), 3 (3.8 ± 0.6 vs 7.1 ± 0.5 ng/mL, P < 0.0001), and 7 (4.7 ± 0.7 vs 11.0 ± 0.8 ng/mL, P < 0.0001) of severe sepsis. In contrast, plasma Ang-2 levels were higher in nonsurvivors than in survivors only on day 1 (15.8 ± 2.0 vs 9.5 ± 1.2 ng/mL, P = 0.035). VEGF and Tie-2 levels were not associated with MODS and mortality. Ang-1 level less than the median value was the only independent predictor of mortality (hazard ratio, 2.57; 95% CI 1.12–5.90, P = 0.025). Persistently decreased Ang-1 levels are associated with MODS and subsequently, mortality in patients with sepsis.