摘要
目的探讨可溶性生长刺激表达基因2蛋白(soluble growth-stimulated expressed gene 2 protein,sST2)与脓毒症患者28 d全因死亡率的关系。方法本研究为回顾性队列研究,连续纳入2020年1月至2023年12月在南通大学附属医院急诊科接受sST2检测的402例脓毒症患者。根据血清sST2水平的四分位数分为Q1组(<58 ng/ml)、Q2组(58~<84 ng/ml)、Q3组(84~<100 ng/ml)和Q4组(≥100 ng/ml),比较患者基线特征。采用Kaplan-Meier曲线和log-rank检验分析组间28 d生存率的差异。多因素Cox比例风险回归模型评估sST2水平与脓毒症患者28 d全因死亡率之间的关联。采用限制性立方样条曲线(restricted cubic spline curve,RCS)检验sST2与28 d全因死亡率之间的非线性关系。受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)分析sST2预测28 d全因死亡率的最佳截断点。结果最终纳入402例患者,28 d全因死亡率为16.67%,Q1组死亡率最低(5.05%),Q4组死亡率最高(26.47%),28 d全因死亡率随sST2水平上升呈递增趋势(P<0.001)。调整混杂因素后,sST2/10每增加1个单位,死亡风险增加13%(HR=1.13,95%CI:1.06~1.19,P<0.001);以Q1组为参考组,与其相比,Q4组28 d全因死亡风险显著增高(HR=3.20,95%CI:1.18~8.66,P=0.022,P趋势性=0.032)。RCS显示sST2与28 d全因死亡率呈线性关系。ROC显示sST2对脓毒症患者28 d死亡率预测的最佳截断点为67.5 ng/ml,敏感度88%(95%CI:0.80~0.96),特异度41%(95%CI:0.35~0.46)。结论sST2可能对脓毒症患者的28 d全因死亡率有一定的预测价值。
Objective To investigate the relationship between growth-stimulated expressed gene 2 protein(sST2)and 28-day all-cause mortality in patients with sepsis.Methods This was a retrospective cohort study that consecutively included 402 patients with sepsis who underwent sST2 testing from January 2020 to December 2023 in the Department of Emergency of Nantong University Hospital.Patients were divided into four groups according to the quintiles of serum sST2 levels:Q1(<58 ng/ml)、Q2(58-<84 ng/ml)、Q3(84-<100 ng/ml),and Q4(≥100 ng/ml),and the baseline characteristics were compared among the groups.Differences in 28-day survival between the groups were analyzed using Kaplan-Meier curves and log-rank tests.Multivariate Cox regression models were used to assess the association between sST2 levels and 28-day all-cause mortality in patients with sepsis.Restricted cubic spline curve(RCS)were used to test the nonlinear relationship between sST2 and 28-day all-cause mortality.Receiver operator characteristic curve(ROC)was generated to analyze the best cutoff value of sST2 for mortality prediction in patients with sepsis.Results A total of 402 patients with sepsis were enrolled,with a 28-day all-cause mortality rate of 16.67%.The mortality was lowest in the Q1 group and highest in the Q4 group,with an increasing trend(P<0.001).After adjusting for confounders,the risk of 28-day all-cause mortality increased by 13%per unit increase in sST2/10(HR=1.13,95%CI:1.06-1.19,P<0.001).The highest sST2 level group Q4 was independently associated with 28-day all-cause mortality compared to the reference group Q1(HR=3.20,95%CI:1.18-8.66,P=0.022;P for trend=0.032).RCS curves showed a linear association between sST2 and 28-day all-cause mortality.The concentration of sST2 greater than 67.5 ng/ml was the best cut-off value for the prediction of 28-day mortality by ROC curve,with a sensitivity of 0.88(95%CI:0.80-0.96)and a specificity of 0.41(95%CI:0.35-0.46).Conclusions sST2 may have a predictive value for 28-day all-cause mortality in patients with sepsis.
作者
蒋伟
王辉
黄中伟
黄新忠
Jiang Wei;Wang Hui;Huang Zhongwei;Huang Xinzhong(Department of Emergency,Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China;Department of Nephrology,Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China)
出处
《中国医学前沿杂志(电子版)》
北大核心
2025年第10期54-60,共7页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
国家自然科学基金项目(82170750)
南通市科技局项目(JCZ2022020)。
