血清eCIRP、suPAR预测脓毒症致急性呼吸窘迫综合征患者预后的价值分析OACSTPCD
Analysis of the value of serum eCIRP and suPAR in predicting prognosis in patients with sepsis-induced acute respir-atory distress syndrome
目的 探讨血清细胞外冷诱导RNA结合蛋白(eCIRP)、可溶性尿激酶纤溶酶原激活物受体(suPAR)预测脓毒症致急性呼吸窘迫综合征(ARDS)患者预后的价值.方法 选取 2019 年 1 月—2023 年 6 月上海交通大学医学院附属第九人民医院急诊科收治的脓毒症致ARDS患者84 例(ARDS组),按照1∶1比例选取单纯脓毒症患者84例(非ARDS组),根据预后将脓毒症致ARDS患者分为死亡亚组(37 例)和存活亚组(47 例).采用酶联免疫吸附法检测血清eCIRP、suPAR水平.通过多因素Logistic回归和受试者工作特征(ROC)曲线分析脓毒症致ARDS患者死亡的因素及血清eCIRP、suPAR水平预测价值.结果 与非ARDS组比较,ARDS组血清eCIRP、suPAR水平升高(t/P = 14.330/<0.001、10.632/<0.001);84 例脓毒症致ARDS患者 90d死亡率为 44.05%(37/84);死亡亚组患者血清eCIRP、suPAR、脓毒性休克比例、机械通气时间≥3d比例、序贯器官衰竭评估(SOFA)评分、降钙素原、血乳酸均高于存活亚组(χ2/t/P =13.805/<0.001、5.229/<0.001、10.932/0.001、4.334/0.037、4.850/<0.001、7.592/<0.001、5.926/<0.001);SOFA评分高、血乳酸高及血清eCIRP、suPAR高为脓毒症致ARDS患者死亡的独立危险因素[OR(95%CI)=1.523(1.123～2.067)、2.558(1.123～5.824)、1.094(1.017～1.178)、1.365(1.117～1.670)].血清eCIRP、suPAR及二者联合预测脓毒症致ARDS患者死亡的AUC分别为0.787、0.779、0.871,二者联合的AUC大于血清eCIRP、suPAR水平的单独预测(Z/P =2.005/0.045、2.205/0.028).结论 血清eCIRP、suPAR水平升高与脓毒症致ARDS患者预后不良有关,且二者联合预测的价值较高.
Objective To investigate the prognostic value of serum extracellular cold-induced RNA-binding protein(eCIRP)and soluble urokinase plasminogen activator receptor(suPAR)in patients with sepsis-induced acute respiratory dis-tress syndrome(ARDS).Methods A total of 84 patients with sepsis-induced ARDS(ARDS group)admitted to Ninth Peo-ple's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to June 2023 were enrolled,and 84 patients with pure sepsis(non-ARDS group)were selected in a 1:1 ratio.According to the prognosis,the patients with sepsis-induced ARDS were divided into death subgroup(37 cases)and survival subgroup(47 cases).Enzyme-linked immunosorbent assay was used to measure serum levels of eCIRP and suPAR.The factors causing mortality in ARDS pa-tients with sepsis and the predictive value of serum eCIRP and suPAR levels were analyzed through multiple Logistic re-gression and ROC curve analysis.Results Compared with the non ARDS group,the serum eCIRP and suPAR levels in the ARDS group increased(t/P=14.330/<0.001,10.632/<0.001);The 90 day mortality rate of 84 patients with sepsis induced ARDS was 44.05%(37/84);The serum eCIRP,suPAR,proportion of septic shock,proportion of mechanical ventilation time≥3d,sequential organ failure assessment(SOFA)score,procalcitonin,and blood lactate in the death subgroup were all higher than those in the survival subgroup(χ2/t/P=13.805/<0.001,5.229/<0.001,10.932/<0.001,4.334/0.037,4.850/<0.001,7.592/<0.001,5.926/<0.001);Increased SOFA score,elevated blood lactic acid,eCIRP and suPAR were independent risk factors for death in patients with sepsis-induced ARDS[OR(95%CI)=1.523(1.123-2.067),2.558(1.123-5.824),1.094(1.017-1.178),1.365(1.117-1.670)].The AUC of serum eCIRP,suPAR,and their combination for predicting the death of patients with sepsis-induced ARDS was 0.787,0.779,and 0.871,respectively.The AUC of the combination of the two levels was greater than that of serum eCIRP or suPAR levels alone(Z/P=2.005/0.045,2.205/0.028).Conclusion Elevated levels of serum eCIRP and suPAR are associated with poor prognosis in sepsis induced ARDS patients,and their combined predic-tive value is high.
王雷;应佑国;夏正新;丁艳芬;董锦秀;袁慧敏;张志飞
201999 上海交通大学医学院附属第九人民医院急诊科
临床医学
脓毒症急性呼吸窘迫综合征细胞外冷诱导RNA结合蛋白可溶性尿激酶纤溶酶原激活物受体预后
SepsisAcute respiratory distress syndromeExtracellular cold-induced RNA-binding proteinSoluble urokinase plasminogen activator receptorPrognosis
《疑难病杂志》 2024 (005)
557-562 / 6
上海市卫生行业临床研究专项项目(20194Y0039) Shanghai Health Industry Clinical Research Special Project(20194Y0039)
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