血清降钙素原和可溶性髓样细胞触发受体-1及可溶性CD_(14)亚型水平联合预测脓毒症患者28d病死率的价值研究

Predictive Value of Serum PCT,sTREM-1 and Presepsin Levels for 28-day Mortality among Patients with Sepsis

目的探讨血清降钙素原(PCT)、可溶性髓样细胞触发受体-1(sTREM-1)、可溶性CD_(14)亚型(Presepsin)水平联合预测脓毒症患者28 d病死率的价值。方法选取2014年7月—2016年4月金华市中心医院急诊重症监护室(EICU)和感染科收住的确诊为脓毒症的患者97例。收集患者一般资料,检测其入院后第1天血清C反应蛋白(CRP)、PCT、sTREM-1、Presepsin水平。随访28 d,记录患者生存情况。血清PCT、sTREM-1、Presepsin水平与急性生理学及慢性健康状况评分系统(APACHEⅡ)评分的相关性分析采用Pearson相关分析;脓毒症患者28 d病死率的影响因素分析及血清PCT、sTREM-1、Presepsin水平联合的Logistic回归方程的计算采用多因素Logistic回归分析;绘制APACHEⅡ评分,血清PCT、sTREM-1、Presepsin水平及后3个指标联合评估脓毒症患者预后的受试者工作特征曲线(ROC曲线)。结果随访28 d后,28例(28.9%)患者死亡。根据随访结果,将患者分为死亡组(28例)和生存组(69例)。死亡组APACHEⅡ评分和血清CRP、PCT、sTREM-1、Presepsin水平高于生存组(P<0.05)。血清PCT、sTREM-1、Presepsin水平与APACHEⅡ评分均呈正相关(P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ评分[OR=1.13,95%CI(1.01,1.64)]及血清PCT[OR=1.66,95%CI(1.14,2.53)]、sTREM-1[OR=2.54,95%CI(1.14,5.83)]、Presepsin[OR=25.11,95%CI(1.58,79.7)]水平是脓毒症患者28 d病死率的影响因素(P<0.05)。APACHEⅡ评分和血清PCT、sTREM-1、Presepsin水平预测脓毒症患者28 d病死率的ROC曲线下面积(AUC)分别为0.90[95%CI(0.82,0.95)]、0.87[95%CI(0.78,0.93)]、0.90[95%CI(0.82,0.95)]、0.85[95%CI(0.77,0.92)]。血清PCT、sTREM-1、Presepsin水平联合的Logistic回归方程为Y=-1.218 9+0.032 96×PCT+0.061 25×sTREM-1+0.196 8×Presepsin,其预测脓毒症患者28 d病死率的AUC为0.99[95%CI(0.94,1.00)]。血清PCT、sTREM-1、Presepsin水平联合预测脓毒症患者28 d病死率的AUC大于APACHEⅡ评分和血清PCT、sTREM-1、Presepsin水平预测脓毒症患者28 d病死率的AUC(P<0.05)。结论血清PCT、sTREM-1、Presepsin水平联合预测脓毒症患者28 d病死率的价值优于单一指标,这具有重要的参考价值及临床意义,有助于临床决策。

Objective To investigate the predictive value of serum procalcitonin（ PCT） combined with soluble triggering receptor expressed on myeloid cells-1（ sTREM-1） and soluble CD_（14） subtype（ Presepsin） levels for 28-day mortality among patients with sepsis. Methods A total of 97 patients with sepsis receiving inpatient treatment in Department of EICU or Department of Infectious Diseases,Central Hospital of Jinhua from July 2014 to April 2016 were enrolled. Demographic data of the patients were collected. The serum levels of CRP,PTC,sTREM-1 and Presepsin were measured on the first day after admission. All of them were followed up for 28 days for investigating the survival status. Pearson correlation analysis was conducted to analyze the correlation of serum levels of PCT,sTREM-1 and Presepsin with APACHEⅡ. The influencing factors of 28-d mortality in sepsis patients were explored and the Logistic regression equation of serum levels of PCT,sTREM-1 and Presepsin were calculated by multivariate Logistic regression analysis. The receiver operating characteristic（ ROC） curves for evaluating prognosis of patients with sepsis by APACHE Ⅱ score,serum levels of PCT,sTREM-1 and Presepsin alone,serum levels of PCT,sTREM-1 and Presepsin jointly were drawn. Results According to the follow-up results,the patients were divided into death group [28 cases（ 28. 9%） ]and survival group（ 69 cases）. The APACHE Ⅱ score, serum levels of CRP, PCT,sTREM-1 and Presepsin of death group were higher than those of survival group（ P〈 0. 05）. Serum levels of PCT,sTREM-1,Presepsin were positively correlated with APACHE Ⅱ score（ P〈 0. 05）. Multivariate Logistic regression analysis showed that APACHE Ⅱ score [OR = 1. 13,95% CI（ 1. 01,1. 64） ]and serum levels of PCT [OR = 1. 66,95% CI（ 1. 14,2. 53） ],sTREM-1 [OR = 2. 54,95% CI（ 1. 14,5. 83） ],Presepsin [OR = 25. 11,95% CI（ 1. 58,79. 7） ]were the influencing factors of 28-d mortality in sepsis patients（ P〈 0. 05）. The area under the ROC curve（ AUC） of 28-d mortality in sepsis patients predicted by APACHE Ⅱ score,serum levels of PCT,sTREM-1 and Presepsin was 0. 90 [95% CI（ 0. 82,0. 95） ],0. 87 [95% CI（ 0. 78,0. 93） ],0. 90 [95% CI（ 0. 82,0. 95） ]and 0. 85 [95% CI（ 0. 77,0. 92） ], respectively. The Logistic regression equation of serum levels of PCT,sTREM-1 and Presepsin was Y =-1. 218 9 ＋ 0. 032 96 × PCT ＋ 0. 061 25× sTREM-1 ＋ 0. 196 8 × Presepsin,and the AUC of 28-d mortality in sepsis patients predicted by it was 0. 99 [95% CI（ 0. 94,1. 00） ]. The AUC of 28-d mortality in sepsis patients predicted by serum levels of PCT,sTREM-1 and Presepsin jointly was greater than that predicted by APACHE Ⅱ score,serum levels of PCT,sTREM-1 and Presepsin alone（ P 0. 05）. Conclusion The value of serum levels of PCT,sTREM-1 and Presepsin in predicting the 28-d mortality in sepsis patients is better than that of single index,which has important reference value and clinical significance, and is helpful for clinical decision-making.