A New Marker of Sepsis Post Burn Injury?
A New Marker of Sepsis Post Burn Injury?
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DOI：
10.1097/ccm.0000000000000400
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发表时间：
2014-09-01
影响因子：
8.8
通讯作者：
Paterson, David L.
中科院分区：
文献类型：
--
作者：
Paratz, Jennifer D.;Lipman, Jeffrey;Paterson, David L.
目的：烧伤后脓毒症的诊断是一个困难的问题，因为严重的创伤会产生大量的炎症反应。我们的目的是评估血清N-末端B型利钠肽前体和降钙素原的值以及作为危重烧伤患者脓毒症标志物的血流动力学变量的变化。设计：前瞻性观察性研究。设置：四级大学附属ICU。患者：54例烧伤总体表面积大于或等于15%、插管且既往无心血管合并症的患者，干预措施：在入院时，连接FloTrac/Vigileo系统，每天从动脉导管采集血液样本。每天对根据美国烧伤共识标准分类为脓毒症/非脓毒症的患者进行感染监测。N末端B型利钠肽原，降钙素原，在烧伤后的前24小时内和此后的ICU住院时间内或直到他们的第一次发作，每天测量每搏输出量指数和全身血管阻力指数的变化和波形分析。败血症记录每搏输出量变异小于12%（正常血容量）伴低血压（收缩压< 90 mm Hg）的患病率。在第3-7天，脓毒症患者与“无脓毒症”患者的N末端前B型利钠肽、全身血管阻力指数和每搏输出量指数存在显著差异。除第3天外，脓毒症和“无脓毒症”之间的降钙素原无差异。受试者工作特征曲线下面积对B型利钠肽显示出极好的鉴别能力（p = 0.001; 95% CI，0.99-1.00），体循环血管阻力指数（p < 0.001; 95%CI，0.97-0.99）和每搏输出量指数（p < 0.01; 95%CI，0.96-0.99）预测脓毒症，但不能预测降钙素原（不显著; 95%CI，0.29-0.46）。卡方交叉表显示，低血压伴正常血容量（每搏输出量变异< 12%）与脓毒症无相关性。结论：血清N末端B型利钠肽原水平和某些血流动力学改变可作为烧伤患者脓毒症的早期指标。降钙素原对脓毒症的早期诊断无帮助。
Objectives: Accurate diagnosis of sepsis is difficult in patients post burn due to the large inflammatory response produced by the major insult. We aimed to estimate the values of serum N-terminal pro-B-type natriuretic peptide and procalcitonin and the changes in hemodynamic variables as markers of sepsis in critically ill burn patients.Design: Prospective, observational study.Setting: A quaternary-level university-affiliated ICU.Patients: Fifty-four patients with burns to total body surface area of greater than or equal to 15%, intubated with no previous cardiovascular comorbidities, were enrolled.Interventions: At admission, a FloTrac/Vigileo system was attached and daily blood samples taken from the arterial catheter. Infection surveillance was carried out daily with patients classified as septic/nonseptic according to American Burns Consensus criteria.Measurements and Main Results: N-terminal pro-B-type natriuretic peptide, procalcitonin, and waveform analysis of changes in stroke volume index and systemic vascular resistance index were measured within the first 24 hours after burn and daily thereafter for the length of the ICU stay or until their first episode of sepsis. Prevalences of stroke volume variation less than 12% (normovolemia) with hypotension (systolic blood pressure < 90 mm Hg) were recorded. Patients with sepsis differed significantly from "no sepsis" for N-terminal pro-B-type natriuretic peptide, systemic vascular resistance index, and stroke volume index on days 3-7. Procalcitonin did not differ between sepsis and "no sepsis" except for day 3. Area under the receiver operating characteristic curves showed excellent discriminative power for B-type natriuretic peptide (p = 0.001; 95% CI, 0.99-1.00), systemic vascular resistance index (p < 0.001; 95% CI, 0.97-0.99), and stroke volume index (p < 0.01; 95% CI, 0.96-0.99) in predicting sepsis but not for procalcitonin (not significant; 95% CI, 0.29-0.46). A chi-square crosstab found that there was no relationship between hypotension with normovolemia (stroke volume variation < 12%) and sepsis.Conclusions: Serum N-terminal pro-B-type natriuretic peptide levels and certain hemodynamic changes can be used as an early indicator of sepsis in patients with burn injury. Procalcitonin did not assist in the early diagnosis of sepsis.