[1]张士跃,刘红栓a,刘春来,等.脓毒症患者应用内皮激活和应激指数评分系统对短期预后的预测价值研究[J].现代检验医学杂志,2025,40(01):174-178.[doi:10.3969/j.issn.1671-7414.2025.01.033]
　ZHANG Shiyue,LIU Hongshuana,LIU Chunlai,et al.Predictive Value of Using Endothelial Activation and Stress Index Scoring System for Short-term Prognosis in Sepsis Patients[J].Journal of Modern Laboratory Medicine,2025,40(01):174-178.[doi:10.3969/j.issn.1671-7414.2025.01.033]
点击复制

脓毒症患者应用内皮激活和应激指数评分系统对短期预后的预测价值研究()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年01期
页码:
174-178
栏目:
论著
出版日期:
2025-01-15

文章信息/Info

Title:
Predictive Value of Using Endothelial Activation and Stress Index Scoring System for Short-term Prognosis in Sepsis Patients
文章编号:
1671-7414（2025）01-174-05
作者:
张士跃1; 刘红栓2a; 刘春来1; 许 兴2b
（1. 北京市通州区中西医结合医院，北京 101100；2. 北京中医药大学东直门医院通州院区 a. 重症监护室 ；b. 检验科，北京 101100）
Author(s):
ZHANG Shiyue1; LIU Hongshuan2a; LIU Chunlai1; XU Xing2b
（1. the Tongzhou District Integrated Traditional Chinese and Western Medicine Hospital of Beijing，Beijing 101100，China；2a. Department of Intensive Care Unit； 2b. Department of Clinical Laboratory，Tongzhou Campus,Dongzhimen Hospital of Beijing University o
关键词:
内皮激活和应激指数; 脓毒症
分类号:
R631；R446
DOI:
10.3969/j.issn.1671-7414.2025.01.033
文献标志码:
A
摘要:
目的 探讨内皮激活和应激指数（EASIX）与脓毒症病程和生存结局的关系。方法 回顾性分析2019 年3月～ 2023 年3 月北京中医药大学东直门医院通州院区收治的符合脓毒症3.0（Sepsis-3）定义的197 例患者，根据病程进展和生存结局分组。脓毒症严重程度采用脓毒症相关器官衰竭评分(SOFA) 和急性生理和慢性健康评估（APACHEII）系统。EASIX 评分由乳酸脱氢酶、血小板和肌酐组成。多因素COX 回归模型分析脓毒症不良预后的影响因素；受试者工作特征（ROC）曲线分析EASIX，SOFA 和APACHE II 评分对脓毒症病程和30 天死亡的预测价值，并根据EASIX 最佳截断值对患者分组，绘制Kaplan-Meier 生存曲线。结果 与脓毒症组比较，脓毒症休克组EASIX（2.55±0.54 vs 2.30±0.49）、APACHE Ⅱ评分（16.47±4.10 vs 11.81±4.89）、SOFA 评分（8.66±3.00 vs 5.48±3.92）明显升高，差异具有统计学意义（t=-3.293，-7.255，-6.431，均P ＜ 0.001），且EASIX 随病程进展而显著升高。脓毒症组（n=92）和脓毒症休克组（n=105）的30 天累积死亡率分别为11.96%（11/92）和29.52%（31/105）。EASIX 与SOFA，APACHE II 评分呈正相关（r=0.662，0.425，均P<0.05），并随病程进展而显著升高（t=3.293，P=0.001）。多因素COX 分析显示EASIX 升高是脓毒症休克组30 天死亡的独立危险因素［OR（95%CI）：1.282（1.135 ～ 1.449），P=0.001］；ROC 曲线分析显示，EASIX 对脓毒症患者30 天死亡的预测性能与APACHE II，SOFA 评分相当，差异无统计学意义（Z=1.208，0.538，P=0.227，0.591）。Kaplan-Meier 生存曲线分析显示，EASIX ＞ 2.43 脓毒症患者30 天病死率显著高于EASIX ≤ 2.43 患者（Log-Rank χ2=18.76，P ＜ 0.001）。结论 EASIX 是预测脓毒症短期预后不良的潜在生物标志物。
Abstract:
Objective To explore the relationship between of endothelial activation and stress index (EASIX) and the course and survival ending of sepsis. Methods A retrospective analysis of 197 patients meeting the definition of sepsis 3.0 were admitted to the Tongzhou Campus, Dongzhimeng Hospital of Beijing University of Chinese Medicine from March 2019 to March 2023, and grouped according to the course of disease and prognosis. The SOFA score and APACHE II score were used to assess the severity of sepsis. The EASIX index consists of lactate dehydrogenase, creatinine, and platelets. Multivariate COX regression model analysis of factors affecting poor prognosis in sepsis. The receiver operator characteristic (ROC ) curve was drawn to investigate the predictive value of EASIX, SOFA and APACHE II scores for the course and 30-day mortality in patients with sepsis. Patient subgroup analysis was performed according to the best cut-off value, and Kaplan-Meier survival curves were drawn. Results Compared with the sepsis group , the EASIX (2.55±0.54 vs 2.30±0.49) , APACHE II (16.47±4.10 vs 11.81±4.89), SOFA(8.66±3.00 vs 5.48±3.92) scores of the septic shock group were significantly in creased , and EASIX also increased significantly with the progression of the disease, with statistically significant differences(t=-3.293, -7.255, -6.431, all P＜0.001). The 30-day mortality rates in the sepsis and septic shock groups were 11.96 % and 29.52%, respectively. EASIX was positively correlated with SOFA scores and APACHE II scores (r=0.662，0.425，all P<0.05)，and increased with the progression of the disease course(t=3.293, P=0.001). Multivariate COX regression analysis showed that elevated EASIX was an independent risk factor for 30-day death in septic shock［OR（95%CI）：1.282（1.135 ～ 1.449），P=0.001］. The ROC curve analysis showed that the predictive performance of EASIX for 30-day mortality in septic patients compared with APACHE II and SOFA scoring, with no statistically significant difference (Z=1.208, 0.538， P=0.227, 0.591). The Kaplan-Meier survival curve analysis showed that the 30-day mortality of sepsis patients in the EASIX > 2.43 group was significantly higher than that in the EASIX ≤ 2.43 group (Log-Rank χ2=18.76，P <0.001). Conclusion EASIX is a potential biomarker for predicting poor short-term prognosis in sepsis.

参考文献/References:

[1] SINGER M, DEUTSCHMAN C S, SEYMOUR C W, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 801-810.
[2] RUDD K E, JOHNSON S C, AGESA K M, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study[J]. Lancet (London, England), 2020, 395(10219): 200-211.
[3] PIOTTI A, NOVELLI D, MEESSEN J M T A, et al. Endothelial damage in septic shock patients as evidenced by circulating syndecan-1, sphingosine-1-phosphate and soluble VE-cadherin: a substudy of ALBIOS[J]. Critical Care (London, England), 2021, 25(1): 113.
[4] JOFFRE J, HELLMAN J, INCE C, et al. Endothelial responses in sepsis[J]. American Journal of Respiratory and Critical Care Medicine, 2020, 202(3): 361-370.
[5] LIU Zhengting, LIU Feng, LIU Cong, et al. Association between lactate dehydrogenase and 30-day mortality in patients with sepsis: a retrospective cohort study [J]. Clinical Laboratory, 2023, 69(6). doi: 10.7754/Clin. Lab.2022.220915.
[6] LI Ming, HUANG Peijie, XU Weiwei, et al. Risk factors and a prediction model for sepsis: a multicenter retrospective study in China[J].Journal of Intensive Medicine, 2022, 2(3): 183-188.
[7] WANG Danni, WANG Suning, WU Hao, et al. Association between platelet levels and 28-day mortality in patients with sepsis: a retrospective analysis of a large clinical database MIMIC-IV[J]. Frontiers in Medicine (Lausanne), 2022, 9: 833996.
[8] LUFT T, BENNER A, JODELE S, et al. EASIX in patients with acute graft-versus-host disease: a retrospective cohort analysis[J]. the Lancet Haematology, 2017, 4(9): e414-e423.
[9] ZHOU Gaosheng, LIU Jingjing, ZHANG Hongmin, et al. Elevated endothelial dysfunction-related biomarker levels indicate the severity and predict sepsis incidence[J]. Scientific Reports, 2022, 12(1): 21935.
[10] MIHAJLOVIC D, BRKIC S, LENDAK D, et al. Endothelial biomarkers in the light of new sepsis definition[J]. Biomarkers in Medicine, 2019, 13(5): 341-351.
[11] LUFT T, WENDTNER C M, KOSELY F, et al. EASIX for prediction of outcome in hospitalized SARS-CoV-2 infected patients [J]. Frontiers in Immunology, 2021, 12: 634416.
[12] LUFT T, BENNER A, TERZER T, et al. EASIX and mortality after allogeneic stem cell transplantation[J]. Bone Marrow Transplantation, 2020, 55(3): 553-561.
[13] VERMA S K, MOLITORIS B A. Renal endothelial injury and microvascular dysfunction in acute kidney injury[J]. Seminars in Nephrology, 2015, 35(1): 96-107.
[14] 王瑞雪．血小板在脓毒症中的关键作用[J]. 临床与病理杂志,2021.41(4):904-909. WANG Ruixue. Key role of platelets in sepsis[J]. Journal of Clinical and Pathological Research, 2021, 41(4): 904-909.
[15] 王胜标，李涛，李云峰，等. 4 种评分系统对脓毒症患者预后的评估价值: 附311 例回顾性分析[J].中国危重病急救医学, 2017, 29(2): 133-138. WANG Shengbiao, LI Tao, LI Yunfeng, et al. Predictive value of four different scoring systems for septic patient’s outcome: a retrospective analysis with 311 patients[J]. Chinese Critical Care Medicine,2017, 29(2): 133-138.

相似文献/References:

[1]沈丽娟a,孙 杰a,吴 晓b,等.老年脓毒症患者血清清蛋白水平与其危重程度及预后的相关性[J].现代检验医学杂志,2017,32(01):131.[doi:10.3969/j.issn.1671-7414.2017.01.036]
　SHEN Li-juana,SUN Jiea,WU Xiaob,et al.Relationship of Albumin Levels with the Prognosis and Severity of Illness among Elderly Sepsis Patients[J].Journal of Modern Laboratory Medicine,2017,32(01):131.[doi:10.3969/j.issn.1671-7414.2017.01.036]
[2]佟 丽,黄丽萍,石晓霞,等.血栓弹力图检测新型冠状病毒肺炎患者凝血功能的探讨分析[J].现代检验医学杂志,2020,35(04):97.[doi:10.3969/j.issn.1671-7414.2020.04.024]
　TONG Li,HUANG Li-ping,SHI Xiao-xia,et al.Investigation and Analysis of Thromboelastography in the Detection of COVID-19 Patients[J].Journal of Modern Laboratory Medicine,2020,35(01):97.[doi:10.3969/j.issn.1671-7414.2020.04.024]
[3]肖武强,徐敏丹,吴先正.脓毒症患者血清肠型脂肪酸结合蛋白、二胺氧化酶水平检测对早期肠组织损伤及预后的评估价值[J].现代检验医学杂志,2021,36(01):10.[doi:10.3969/j.issn.1671-7414.2021.01.003]
　XIAO Wu-qiang,XU Min-dan,WU Xian-zheng.Evaluation Value of Serum Intestinal Fatty Acid Binding Protein and Diamine Oxidase in the Early Stage of Intestinal Tissue Injury and Prognosis in Patients with Sepsis[J].Journal of Modern Laboratory Medicine,2021,36(01):10.[doi:10.3969/j.issn.1671-7414.2021.01.003]
[4]张　晨,孙虹佳.新型感染标志物在脓毒症早期诊断中的应用及研究进展[J].现代检验医学杂志,2021,36(01):156.[doi:10.3969/j.issn.1671-7414.2021.01.038]
　ZHANG Chen,SUN Hong-jia.Latest Research Progress of Early Serum Inflammatory and Oxidative Stress Mediator of Sepsis[J].Journal of Modern Laboratory Medicine,2021,36(01):156.[doi:10.3969/j.issn.1671-7414.2021.01.038]
[5]张　珍,王新庄.脓毒症患者血清 YKL-40 水平检测与急性肾损伤早期诊断的相关性研究[J].现代检验医学杂志,2021,36(03):148.[doi:10.3969/j.issn.1671-7414.2021.03.034]
　ZHANG Zhen,WANG Xin-zhuang.Correlation between Serum YKL-40 Level and Early Diagnosis of AcuteKidney Injury in Patients with Sepsis[J].Journal of Modern Laboratory Medicine,2021,36(01):148.[doi:10.3969/j.issn.1671-7414.2021.03.034]
[6]王　海,肖　华,陈兴壮.血浆miR-223-3p，PCT，IL-6和CRP水平联合检测对脓毒症实验诊断及预后的价值研究[J].现代检验医学杂志,2021,36(05):51.[doi:10.3969/j.issn.1671-7414.2021.05.011]
　WANG Hai,XIAO Hua,CHEN Xing-zhuang.Value of Combined Detection of Plasma miR-223-3p, PCT, IL-6 and CRPLevels in Experimental Diagnosis and Prognosis of Sepsis[J].Journal of Modern Laboratory Medicine,2021,36(01):51.[doi:10.3969/j.issn.1671-7414.2021.05.011]
[7]洪　莉,郑　青,陈永香,等.脓毒症并发急性肾损伤患儿血清miR-452-3p的水平表达及其临床意义[J].现代检验医学杂志,2021,36(06):176.[doi:10.3969/j.issn.1671-7414.2021.06.038]
　HONG Li,ZHENG Qing,CHEN Yong-xiang,et al.Expression and Clinical Significance of Serum miR-452-3p in Children with Sepsis Complicated with Acute Kidney Injury[J].Journal of Modern Laboratory Medicine,2021,36(01):176.[doi:10.3969/j.issn.1671-7414.2021.06.038]
[8]李炳奇,叶俊伟,梅喜平,等.脓毒症患者血液激活素 a，CRP，HMGB1和 vWF表达水平及临床意义[J].现代检验医学杂志,2022,37(01):97.[doi:10.3969/j.issn.1671-7414.2022.01.020]
　LI Bing-qi,YE Jun-wei,MEI Xi-ping,et al.Blood Activator A, CRP, HMGB1 and vWF Expression Levels and Clinical Significance in Patients with Sepsis[J].Journal of Modern Laboratory Medicine,2022,37(01):97.[doi:10.3969/j.issn.1671-7414.2022.01.020]
[9]胡　伟,张　涛,盛尚春,等.IGF-1R通过调控JAK/STAT信号通路对脓毒症大鼠作用机制的研究[J].现代检验医学杂志,2022,37(02):6.[doi:10.3969/j.issn.1671-7414.2022.02.002]
　HU Wei,ZHANG Tao,SHENG Shang-chun,et al.Mechanism of IGF-1R on Sepsis Rats by Regulating JAK / STAT Signaling Pathway[J].Journal of Modern Laboratory Medicine,2022,37(01):6.[doi:10.3969/j.issn.1671-7414.2022.02.002]
[10]于大勇a,卢　新b,任平香b,等.老年脓毒症患者血清循环Netrin-1表达水平对发生脑损伤风险的预测价值研究[J].现代检验医学杂志,2022,37(02):76.[doi:10.3969/j.issn.1671-7414.2022.02.016]
　YU Da-yonga,LU Xinb,REN Ping-xiangb,et al.Study on the Value of Serum Circulating Netrin-1 Expression Level in Predicting the Risk of Brain Injury in Elderly Patients with Sepsis[J].Journal of Modern Laboratory Medicine,2022,37(01):76.[doi:10.3969/j.issn.1671-7414.2022.02.016]

备注/Memo

备注/Memo:
作者简介：张士跃(1977- )，男，本科，副主任技师，研究方向：临床生物化学，E-mail：liuchunlai520@126.com。
通讯作者：许兴（1980-），男，本科，主管技师，研究方向：临床生物化学，E-mail：75030643@qq.com。
更新日期/Last Update: 2025-01-15