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Published on: January 28, 2020
Serum level of soluble CD14 subtype predicts long-term prognosis in sepsis patients with cardiac dysfunction
Junliang Liu1, Mingying Dai2, Hongyun Yang3
1ICU, Renmin Hospital of Chengyang District, Qingdao, China.
Insights
High baseline serum levels of soluble CD14 subtype (sCD14-ST) predict poor prognosis in sepsis-induced cardiac dysfunction (SICD) patients. Major adverse cardiovascular events (MACEs) predominantly occurred within 3 months post-discharge.
Area of Science:
- Cardiology
- Critical Care Medicine
- Immunology
Background:
- Sepsis can lead to life-threatening cardiac dysfunction (SICD).
- Predicting SICD and its outcomes is crucial for patient management.
- Soluble CD14 subtype (sCD14-ST) shows potential as a sepsis biomarker.
Purpose of the Study:
- To evaluate the predictive value of sCD14-ST for SICD.
- To assess the association between sCD14-ST levels and major adverse cardiovascular events (MACEs) in SICD patients.
Main Methods:
- 117 SICD patients from three ICUs were enrolled between 2015-2018.
- Serum sCD14-ST levels were measured at admission.
- Patients were followed for 1 year to record MACEs and repeat echocardiography.
Main Results:
- 35% of patients experienced MACEs within 1 year, mostly within 3 months post-discharge.
- sCD14-ST, age, cardiac troponin T, creatine, and SOFA score predicted MACEs.
- sCD14-ST demonstrated an AUROC of 0.784 for predicting MACEs.
Conclusions:
- MACEs in SICD patients primarily occur within 3 months after discharge.
- Elevated baseline sCD14-ST levels are indicative of a poor prognosis in SICD.
Background:
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and some sepsis patients will develop cardiac dysfunction. Sepsis-induced cardiac dysfunction (SICD) has been demonstrated to be a promising predictor of mortality, although the prediction of SICD itself remains unclear. Clinical studies have shown that soluble CD14 subtype (sCD14-ST) may be a useful predictor for sepsis. In this study, we aimed to evaluate the predictive value of sCD14-ST for SICD in patients with sepsis.
Methods:
Patients with SICD from three intensive care units (ICUs) of three medical centers between January 2015 and December 2018 were enrolled. Clinical data and information were collected from hospital and clinic records. Blood samples at admission were collected and serum levels of sCD14-ST were tested. Patients were followed up for at least 1 year. Major adverse cardiovascular events (MACEs) were recorded. Echocardiography was repeated at the end of 1-year follow-up.
Results:
A total of 117 patients were enrolled into the final analysis. During 1-year follow-up, MACEs occurred in 35 (29.9%) patients. Most MACEs occurred with 3 months after discharge. Univariate and multivariate analysis revealed that age (OR =1.5, 95% CI: 1.2-2.3, P=0.036), cardiac troponin T (cTnT) (OR =1.4, 95% CI: 1.2-2.1, P=0.027), creatine (Cr) (OR =1.6, 95% CI: 1.3-2.5, P=0.022), sequential organ failure assessment (SOFA) score (OR =1.7, 95% CI: 1.3-2.6, P=0.012), and soluble cluster of differentiation 14 subtype (sCD14-ST) (OR =1.9, 95% CI:1.4-3.1, P=0.015) were predictors for MACEs in patients with SICD at 1-year follow-up. Area under receiver operating curve (AUROC) of sCD14-ST to MACEs was 0.784, and the cutoff point was 748.3 μg/L with a sensitivity of 0.78 and a specificity of 0.74 respectively. Blood test at the end of 1-year follow-up revealed that patients with a lower sCD14-ST level had better lower Cr, N-terminal pro-brain natriuretic peptide (NT-proBNP) and higher systolic blood pressure (SBP) and left ventricular ejection fraction (LVEF).
Conclusions:
MACEs mainly occurred within 3 months after discharge in patients with SICD, and high baseline serum levels of sCD14-ST predicted poor prognosis in patients with SICD.
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