SEPSIGN:在急诊室早期识别败血症的迹象
Thomas Lafon1, Marie-Angélique Cazalis2, Kimberly W Hart3
1Emergency Department and Inserm CIC 1435, Dupuytren University Hospital, 2 Avenue Martin Luther King, 87042, Limoges, France. thomas.lafon@chu-limoges.fr.
Internal and emergency medicine
|October 31, 2024
概括
生物标志物如可溶性血管内皮生长因子受体2 (sVEGFR2) 和可溶性尿激酶激活体受体 (suPAR) 可以帮助预测败血症患者的恶化. 将这些与临床数据相结合,为识别高风险患者提供了最佳的准确性.
科学领域:
- 生物标志物 生物标志物
- 败血症病理生理学病理生理学
- 临床预后 临床预后
背景情况:
- 败血症影响20-30%的患者,导致严重疾病.
- 准确的早期预后生物标志物对于治疗决策和患者出院至关重要.
- 识别患有恶化风险的患者对于及时干预至关重要.
研究的目的:
- 评估sVEGFR2,suPAR和PCT对败血症患者临床恶化的预测性表现.
- 评估这些生物标志物与临床征兆和症状的联合实用性.
- 确定需要密集治疗的患者与符合提前出院资格的患者.
主要方法:
- 在16个急诊室进行前性观察研究.
- 注册的患者怀疑感染符合SIRS标准,没有器官功能障碍 (delta SOFA <2).
- 主要终点:临床恶化 (SOFA评分增加≥2,新器官支持或死亡) 在72小时内.
主要成果:
- 在724名 (24%) 患者中,有176名患者出现了临床恶化.
- 病情恶化的患者的sVEGFR2水平较低,suPAR水平较高,PCT水平较高.
- 与PCT (AUC=0.57) 和sVEGFR2 (AUC=0.58) 相比,suPAR显示出更高的性能 (AUC=0.65).
- 临床信息,sVEGFR2和suPAR的组合获得了最高的准确性 (AUC=0.74),负预测值 (NPV) 为0.90.
结论:
- 临床数据与sVEGFR2和suPAR的结合显示出预测败血症患者恶化的前景.
- 单个生物标志物sVEGFR2和suPAR不足以排除临床恶化.
- 生物标志物的面板可能是必要的,以解决与败血症相关的器官衰竭的异质机制.
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