Diagnostic and prognostic implications of endotoxemia in critical illness: Results of the MEDIC study
Diagnostic and prognostic implications of endotoxemia in critical illness: Results of the MEDIC study
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DOI：
10.1086/422254
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发表时间：
2004-08-01
影响因子：
6.4
通讯作者：
Romaschin, A
中科院分区：
文献类型：
--
作者：
Marshall, JC;Foster, D;Romaschin, A
一种新的内毒素检测方法，基于抗原抗体复合物激发中性粒细胞增强呼吸爆发反应的能力，在一项对857例重症监护室（ICU）患者的队列研究中进行了研究。在入住ICU当天，57.2%的患者具有中等（大于或等于0.40内毒素活性[EA]单位）或高（大于或等于0.60单位）EA水平。革兰阴性菌感染存在于1.4%的患者与低EA水平，4.9%与中间水平，6.9%与高水平; EA有85.3%的灵敏度和44.0%的特异性诊断革兰阴性菌感染。低、中和高EA水平患者的严重脓毒症发生率分别为4.9%、9.2%和13.2%，ICU死亡率分别为10.9%、13.2%和16.8%。逐步Logistic回归分析显示，急性生理学和慢性健康评估II评分升高，革兰氏阴性菌感染，急诊入院状态是EA的独立预测因子。
A novel assay for endotoxin, based on the ability of antigen-antibody complexes to prime neutrophils for an augmented respiratory burst response, was studied in a cohort study of 857 patients admitted to an intensive-care unit (ICU). On the day of ICU admission, 57.2% of patients had either intermediate (greater than or equal to0.40 endotoxin activity [EA] units) or high (greater than or equal to0.60 units) EA levels. Gram-negative infection was present in 1.4% of patients with low EA levels, 4.9% with intermediate levels, and 6.9% with high levels; EA had a sensitivity of 85.3% and a specificity of 44.0% for the diagnosis of gram-negative infection. Rates of severe sepsis were 4.9%, 9.2%, and 13.2%, and ICU mortality was 10.9%, 13.2%, and 16.8% for patients with low, intermediate, and high EA levels, respectively. Stepwise logistic regression analysis showed that elevated Acute Physiology and Chronic Health Evaluation II score, gram-negative infection, and emergency admission status were independent predictors of EA.