早期分析内皮标志物,预测急诊科败血症。

IF 2.7 3区 医学 Q2 CRITICAL CARE MEDICINE SHOCK Pub Date : 2024-10-02 DOI:10.1097/SHK.0000000000002482
Noa Galtung, Vanessa Stein, Monika Prpic, Burak Boyraz, Jannis Ulke, Stephan Kurz, Jens Dernedde, Eva Diehl-Wiesenecker, Wolfgang Bauer, Kai Kappert
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引用次数: 0

摘要

背景:急性感染和败血症是导致死亡的主要原因。这些患者主要在急诊科(ED)就诊,必须及早评估败血症,以改善预后。脓毒症时,炎症反应会引起几种特征性的病理生理变化,包括内皮失调和普遍激活。本研究旨在分析释放到血液中的内皮标志物,作为急诊室急性感染和脓毒症的诊断生物标志物,因为之前的小型研究已在其他环境中显示出良好的效果:方法: 研究人员采集了 n = 312 名急诊室疑似急性感染成人患者的血清样本。患者的病程和结果由临床判定进行评估。E-选择素、P-选择素、ICAM-1 和 VCAM-1 通过 ELISAs 检测。评估了每种标记物预测细菌感染、败血症和院内死亡率的准确性:结果:对于败血症,E-选择素和ICAM-1的AUROC均为0.62,低于降钙素原的0.77(P均<0.01)和乳酸的0.73(P分别为0.030和0.046),但与CRP的0.60(P分别为0.758和0.876)相似。对于感染患者的 28 天院内死亡率,ICAM-1 的 AUROC 为 0.75,表现最佳:尽管在小型研究和特定队列中,特别是在重症监护病房中取得了令人鼓舞的结果,但对四种内皮生物标志物的大规模评估突出表明,在更广泛的纳入设置设计中,在尽可能早的评估时间点上,这些生物标志物的诊断效用有限。
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Early Analysis of Endothelial Markers to predict Sepsis in the Emergency Department.

Background: Acute infections and sepsis are a leading cause of death. These patients are primarily encountered at the emergency department (ED), where early assessment for sepsis is necessary to improve outcome. In sepsis, the inflammatory response causes several characteristic pathophysiological changes, including a dysregulated and generalized activation of the endothelium. This study aimed to analyse endothelial markers released to the blood as diagnostic biomarkers for acute infection and sepsis in the ED, as smaller studies have previously shown promising results in other settings.

Methods: Serum samples from n = 312 adult patients with suspected acute infections at presentation to the ED were utilized. Patients' courses of disease and outcomes were assessed by clinical adjudication. E-Selectin, P-Selectin, ICAM-1, and VCAM-1 were measured by ELISAs. The accuracy of each marker for predicting bacterial infection, sepsis, and in-hospital mortality, was evaluated.

Results: For sepsis, E-Selectin and ICAM-1 both showed an AUROC of 0.62, lower than procalcitonin with 0.77 (both p < 0.01) and lactate with 0.73 (p = 0.030 and 0.046, respectively), but similar to CRP with 0.60 (p = 0.758 and 0.876, respectively). For 28-day in-hospital mortality among patients with infection, ICAM-1 performed best with an AUROC of 0.75.

Conclusions: Despite promising results in small studies and specific cohorts, particularly in intensive care units, this large-scale evaluation of four endothelial biomarkers highlights their limited diagnostic utility in a broader inclusion set-up design at the earliest possible time-point of evaluation.

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来源期刊
SHOCK
SHOCK 医学-外科
CiteScore
6.20
自引率
3.20%
发文量
199
审稿时长
1 months
期刊介绍: SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.
期刊最新文献
Correcting the Carotid Flow Time with the Formula of Bazett: mind the units. Early Analysis of Endothelial Markers to predict Sepsis in the Emergency Department. Whole transcription analysis identified the regulation of hypoxia-inducible factors in monocytes with immune suppression: implications for clinical outcomes. EFFICACY OF A SEPSIS CLINICAL DECISION SUPPORT SYSTEM IN IDENTIFYING PATIENTS WITH SEPSIS IN THE EMERGENCY DEPARTMENT. CECAL SLURRY AS AN ALTERNATIVE MODEL TO CECAL LIGATION AND PUNCTURE FOR THE STUDY OF SEPSIS-INDUCED CARDIOVASCULAR DYSFUNCTION.
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