血清可溶性白细胞分化抗原14亚型联合动脉乳酸评估脓毒症预后的价值

摘要

Objective To investigate the value of serum soluble leukocyte differentiation antigen 14 subtype (sCD14-ST, Presepsin) combined with arterial lactate for predicting the prognosis of emergency patients with sepsis.Methods We selected 90 patients who came to the emergency department of Beijing Hospital with sepsis from September 2009 to July 2015 as the objects of the study.The serum samples were collected immediately as they came, the Presepsin and lactate were measured.Patients were divided into survival group (57 cases) and death group (33 cases) according to the 30-day prognosis, and the value of the Presepsin, lactate and Presepsin + lactate in the assessment of prognosis were compared.Univariate and multivariate logistic regression analysis were used to analyze the prognostic factors of sepsis patients, and ROC curve to evaluate the prognostic value of serum Presepsin and lactate levels.Results Presepsin and lactate both were higher in the death group than the survival group [1323.0 (942.5, 2304.0) vs.547.0 (297.5, 904.0), P<0.05;3.5 (1.7, 5.8) vs.1.2 (0.8, 2.0), P<005].Univariate and multivariate Logistic regression analysis showed that Presepsin and lactate were independent risk factors for death in patients with sepsis, the OR and CI were 1.002 (1.001, 1.003) and 2.343 (1.428, 3.845), respectively.Under the ROC curve area (AUC) of Presepsin and lactate were 0.829 and 0.848.The combination of Presepsin and lactate was 0.900.When Presepsin≥ 927.5 pg/mL and lactate≥2.35 mmol/L, it can significantly improve the efficacy of predicting prognosis.Conclusion Serum Presepsin is a good indicator to judge the prognosis of patients with sepsis, and the combination with lactate can improve the ability to predict the risk of septic death.%目的 探讨血清可溶性白细胞分化抗原14亚型(sCD14-ST,Presepsin)联合动脉乳酸(lactate,Lac)对急诊脓毒症预后评估的价值.方法 选择北京医院急诊科2012-09~2015-07就诊的脓毒症患者90例作为研究对象,来诊即刻收集血清标本测定Presepsin和Lac.根据30 d生存情况分为生存组(n=57)和死亡组(n=33),比较两组血清Presepsin和Lac水平.应用单因素及多元Logistic回归模型分析影响脓毒症患者预后的危险因素,并绘制ROC曲线评估血清Presepsin和Lac水平对脓毒症患者预后的预测价值.结果 死亡组NT-proBNP、CRE、PaO2与存活组比较差异有统计学意义(P<0.05).死亡组血清Presepsin和动脉Lac水平均高于生存组[分别为1323.0(942.5,2304.0) vs.547.0(297.5,904.0,P<0.05;3.5(1.7,5.8)vs.1.2(0.8,2.0),P<0.05].单因素及多元Logistic回归分析,发现血清Presepsin和Lac是脓毒症患者死亡的独立危险因素,其OR及95%CI分别为1.002(1.001,1.003)、2.343(1.428,3.845).血清Presepsin和Lac的 ROC曲线下面积(AUC)分别为0.829、0.848,两者联合预测值的AUC为0.900.以血清Presepsin≥927.5 pg/mL、Lac≥2.35 mmol/L为界值(cut off)评估不良预后有较好的效能.结论 血清Presepsin是评估脓毒症预后的较好指标,联合Lac能提高对脓毒症死亡风险的预测能力.