血浆Presepsin水平对急诊室脓毒症患者发生多器官功能障碍的预测作用  

Predictive value of Presepsin for septic patients developed with multiple organs dysfunction in emergency department

作　　者：刘波[1] 陈云霞[1] 李薇[2] 李春盛[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020 [2]北京军区总医院附属第263医院感染控制科

出　　处：《中华急诊医学杂志》2015年第8期819-824,共6页Chinese Journal of Emergency Medicine

基　　金：卫生部国家临床重点专科建设项目（2012-649）;北京市优秀博士学位论文专项基金项目（20121002501）

摘　　要：目的本研究探讨入院时Presepsin水平对于急诊室脓毒症患者发生多器官功能障碍（MOD）的预测作用。方法采用前瞻性研究方法，入选2013年11月至2014年10月北京朝阳医院急诊科连续就诊的脓毒症患者680例作为研究对象，记录发生MOD及非MOD的患者，并记录Presepsin、PCT水平和SOFA评分的分值。结果入院时MOD组Presepsin质量浓度为1023．5（728．3—1860．0）pg／mL显著高于非MOD组334．0（218．0～479．5）pg／mL。不同类型器官功能障碍的Presepsin质量浓度比较差异无统计学意义；Presepsin在不同数量器官功能障碍的中位数质量浓度分别为：无器官功能障碍235．0（172．0—340．3）pg／mL，1个器官功能障碍403．5（275．8—587．3）pg／mL，2个器官功能障碍844．5（559．8～I259．5）pg／mL，3个或3个以上器官功能障碍1412．5（893．0～2675．8）pg／mL，差异具有统计学意义（P〈0．01）。Presepsin、PCT和SOFA评分为脓毒症患者发生MOD的独立预测因子；Presepsin预测MOD的ROC曲线下面积（AUCs）为0．914，明显高于PCT（0．756）和SOFA评分（0．840）。结论Presepsin水平在不同类型器官功能障碍的比较差异无统计学意义，Presepsin水平随着脓毒症患者器官功能障碍数量的增加而增加，Presepsin在预测MOD方面优于PCT和SOFA评分。Objective The present study aimed to explore the value of plasma Presepsin levels for predicting the incidence of multiple organs dysfunction （MOD） in septic patients in an emergency department （ED）. Methods A prospective observational study was performed in the ED of Beijing Chao- Yang Hospital from November 2013 to October 2014. A total of 680 septic patients were consecutively enrolled. The septic patients who developed MOD or non-MOD were recorded. Plasma Presepsin and serum procalcitonin （PCT） levels were detected, and sepsis-related organ failure assessment （SOFA） score were calculated upon ED arrival. Results Plasma Presepsin levels at ED admission were significantly higher in patients with MOD [ 1023.5 （728. 3-1 860.0） pg/mL ] than in those without MOD [334. 0 （218. 0-479. 5） pg/mL], and were not different between different types of organ dysfunction. Median Presepsin levels in septic patients with different numbers of organ dysfunction were 235.0 （ 172. 0- 340. 3 ） pg/mL in those with no organ dysfunction, 403.5 （ 275.8-587. 3 ） pg,/mL in those with one organ dysfunction, 844. 5 （559. 8-1 259.5） pg/mL in those with two organs dysfunction, and 1 412. 5 （893.0- 2 675.8）pg/mL in those with three or more than organs dysfunction, respectively, which was statistically significant between every two groups. Presepsin, PCT and SOFA score were all the independent predictors of MOD. The areas under ROC curve （AUCs） of Presepsin for predicting MOD were 0. 914, significantly higher than that of PCT （0. 756） and SOFA score （0. 840）, respectively. Conclusions Plasma Presepsin levels were not different between different types of organ dysfunction. Presepsin levels increased with increasing numbers of organ dysfunction in septic patients, and Presepsin was superior to PCT and SOFA score in predicting the incidence of MOD. In conclusion, Presepsin was a valuable biomarker in evaluating MOD in septic patients in ED.

关 键 词：Presepsin 降钙素 脓毒症 器官功能障碍 脓毒症相关器官功能障碍评分 感染 炎症 生物标记物 

分 类 号：R459.7[医药卫生—急诊医学]