[血浆外泌体计数对脓毒症患者预后的预测价值]。

Q3 Medicine
Wen Li, Yujie Pan, Jing Yan, Li Li
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On the 1st, 3rd, 5th, and 7th day of ICU admission, plasma exosomes were extracted, and the number of exosomes was detected by nanoparticle tracking analyzer. The endpoint of observation was the death of the patient 28 days after admission to the ICU. The differences in baseline data and plasma exosome counts of patients with different 28-day prognosis were analyzed and compared. The Spearman correlation method was used to analyze the correlation between plasma exosome counts and other clinical indicators. Binary multivariate Logistic regression analysis was used to screen the 28-day death risk factors of septic patients. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of each index on the 28-day death of septic patients. The Kaplan-Meier method was used to analyze the 28-day survival curve.</p><p><strong>Results: </strong>A total of 26 patients with sepsis were enrolled, of whom 21 survived and 5 died on the 28th day. Compared with the survival group, the patients in the death group had lower MAP, higher sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, white blood cell count (WBC), cardiac troponin I (cTnI), and worse oxygenation. The plasma exosome count on the 1st day of ICU admission in the death group was significantly higher than that in the survival group (×10<sup>15</sup>/L: 16.96±9.11 vs. 5.20±2.42, P < 0.05). Subsequently, the plasma exosome counts in both groups continued to decrease, and there was no statistically significant difference between the two groups. Spearman correlation analysis showed that the plasma exosome count on the 1st day of ICU admission in septic patients was significantly positively correlated with SOFA score, APACHE II score, blood lactic acid (Lac), alanine aminotransferase (ALT) and NA dosage (r values were 0.572, 0.585, 0.463, 0.411, 0.696, all P < 0.05), and it significantly negatively correlated with MAP and oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>; r values were -0.392 and -0.496, both P < 0.05). Multivariate Logistic regression analysis showed that plasma exosome count on the 1st day of ICU admission was an independent risk factor for 28-day death in septic patients [odds ratio (OR) = 1.385, 95% confidence interval (95%CI) was 1.075-1.785, P = 0.012]. ROC curve analysis showed that the area under the ROC curve (AUC) of plasma exosome count on the 1st day of ICU admission for predicting 28-day death in septic patients was 0.800 (95%CI was 0.449-1.000); when the optimal cut-off value was 14.50×10<sup>15</sup>/L, the sensitivity was 80.0% and the specificity was 100%. According to the optimal cut-off value of 1-day plasma exosome count, the patients were divided into two groups for Kaplan-Meier survival curve analysis, and the results showed that the cumulative survival rate of patients with plasma exosome count < 14.50×10<sup>15</sup>/L was significantly higher than that of patients with plasma exosome count ≥ 14.50×10<sup>15</sup>/L (Log-Rank test: χ <sup>2</sup> = 19.100, P < 0.001).</p><p><strong>Conclusions: </strong>The plasma exosome count of septic patients is significantly increased on the 1st day of admission to the ICU, which is related to the severity, and can predict the risk of death at 28 days.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Predictive value of plasma exosome count for the prognosis in septic patients].\",\"authors\":\"Wen Li, Yujie Pan, Jing Yan, Li Li\",\"doi\":\"10.3760/cma.j.cn121430-20230717-00529\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To investigate the predictive value of plasma exosome count for the prognosis of patients with sepsis.</p><p><strong>Methods: </strong>A prospective observational study was conducted. 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The plasma exosome count on the 1st day of ICU admission in the death group was significantly higher than that in the survival group (×10<sup>15</sup>/L: 16.96±9.11 vs. 5.20±2.42, P < 0.05). Subsequently, the plasma exosome counts in both groups continued to decrease, and there was no statistically significant difference between the two groups. Spearman correlation analysis showed that the plasma exosome count on the 1st day of ICU admission in septic patients was significantly positively correlated with SOFA score, APACHE II score, blood lactic acid (Lac), alanine aminotransferase (ALT) and NA dosage (r values were 0.572, 0.585, 0.463, 0.411, 0.696, all P < 0.05), and it significantly negatively correlated with MAP and oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>; r values were -0.392 and -0.496, both P < 0.05). Multivariate Logistic regression analysis showed that plasma exosome count on the 1st day of ICU admission was an independent risk factor for 28-day death in septic patients [odds ratio (OR) = 1.385, 95% confidence interval (95%CI) was 1.075-1.785, P = 0.012]. ROC curve analysis showed that the area under the ROC curve (AUC) of plasma exosome count on the 1st day of ICU admission for predicting 28-day death in septic patients was 0.800 (95%CI was 0.449-1.000); when the optimal cut-off value was 14.50×10<sup>15</sup>/L, the sensitivity was 80.0% and the specificity was 100%. 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引用次数: 0

摘要

目的:研究血浆外泌体计数对败血症患者预后的预测价值:研究血浆外泌体计数对败血症患者预后的预测价值:方法:进行前瞻性观察研究。研究对象为 2020 年 11 月至 2021 年 12 月入住浙江医院重症监护室(ICU)的败血症患者。入ICU的第1天,记录患者的性别、年龄、基础疾病、感染部位、平均动脉压(MAP)和严重程度评分,抽取静脉血检测血常规、血生化、降钙素原(PCT),抽取动脉血进行血气分析,同时记录患者的去甲肾上腺素(NA)用量。在入住重症监护室的第1天、第3天、第5天和第7天,提取血浆外泌体,用纳米粒子追踪分析仪检测外泌体的数量。观察终点为患者入住重症监护室28天后死亡。分析并比较了不同预后28天患者的基线数据和血浆外泌体数量的差异。采用斯皮尔曼相关法分析血浆外泌体计数与其他临床指标之间的相关性。采用二元多变量 Logistic 回归分析筛选脓毒症患者 28 天死亡风险因素。绘制接收器操作特征曲线(ROC曲线),分析各指标对脓毒症患者28天死亡的预测价值。采用 Kaplan-Meier 法分析 28 天存活率曲线:结果:共纳入了 26 名脓毒症患者,其中 21 人存活,5 人在第 28 天死亡。与存活组相比,死亡组患者的血压较低,器官功能衰竭顺序评估(SOFA)评分、急性生理学和慢性健康评估 II(APACHE II)评分、白细胞计数(WBC)、心肌肌钙蛋白 I(cTnI)较高,氧合情况较差。死亡组在入住重症监护室第一天的血浆外泌体计数明显高于存活组(×1015/L:16.96±9.11 vs. 5.20±2.42,P <0.05)。随后,两组血浆外泌体计数均持续下降,两组间差异无统计学意义。斯皮尔曼相关分析显示,脓毒症患者入ICU第1天的血浆外泌体计数与SOFA评分、APACHE II评分、血乳酸(Lac)、丙氨酸氨基转移酶(ALT)和NA用量呈显著正相关(r值分别为0.572、0.585、0.463、0.411、0.696,均P<0.05),与MAP和氧合指数(PaO2/FiO2;r值分别为-0.392和-0.496,均P<0.05)呈显著负相关。多变量逻辑回归分析显示,ICU入院第一天的血浆外泌体计数是脓毒症患者28天死亡的独立风险因素[比值比(OR)=1.385,95%置信区间(95%CI)为1.075-1.785,P=0.012]。ROC曲线分析显示,ICU入院第一天血浆外泌体计数预测脓毒症患者28天死亡的ROC曲线下面积(AUC)为0.800(95%CI为0.449-1.000);当最佳临界值为14.50×1015/L时,灵敏度为80.0%,特异度为100%。根据1天血浆外泌体计数的最佳临界值,将患者分为两组进行Kaplan-Meier生存曲线分析,结果显示血浆外泌体计数<14.50×1015/L的患者的累积生存率明显高于血浆外泌体计数≥14.50×1015/L的患者(Log-Rank检验:χ 2 = 19.100,P<0.001):脓毒症患者的血浆外泌体计数在进入重症监护室的第一天明显升高,这与病情严重程度有关,并可预测28天后的死亡风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Predictive value of plasma exosome count for the prognosis in septic patients].

Objective: To investigate the predictive value of plasma exosome count for the prognosis of patients with sepsis.

Methods: A prospective observational study was conducted. The patients with sepsis admitted to intensive care unit (ICU) of Zhejiang Hospital from November 2020 to December 2021 were enrolled as the study subjects. On the 1st day of admission to the ICU, the patient's gender, age, underlying disease, infection site, mean arterial pressure (MAP) and severity scores were recorded, and venous blood was taken for detecting the blood routine, blood biochemistry, and procalcitonin (PCT), and arterial blood was taken for blood gas analysis, simultaneously, the patient's noradrenaline (NA) dosage was recorded. On the 1st, 3rd, 5th, and 7th day of ICU admission, plasma exosomes were extracted, and the number of exosomes was detected by nanoparticle tracking analyzer. The endpoint of observation was the death of the patient 28 days after admission to the ICU. The differences in baseline data and plasma exosome counts of patients with different 28-day prognosis were analyzed and compared. The Spearman correlation method was used to analyze the correlation between plasma exosome counts and other clinical indicators. Binary multivariate Logistic regression analysis was used to screen the 28-day death risk factors of septic patients. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of each index on the 28-day death of septic patients. The Kaplan-Meier method was used to analyze the 28-day survival curve.

Results: A total of 26 patients with sepsis were enrolled, of whom 21 survived and 5 died on the 28th day. Compared with the survival group, the patients in the death group had lower MAP, higher sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, white blood cell count (WBC), cardiac troponin I (cTnI), and worse oxygenation. The plasma exosome count on the 1st day of ICU admission in the death group was significantly higher than that in the survival group (×1015/L: 16.96±9.11 vs. 5.20±2.42, P < 0.05). Subsequently, the plasma exosome counts in both groups continued to decrease, and there was no statistically significant difference between the two groups. Spearman correlation analysis showed that the plasma exosome count on the 1st day of ICU admission in septic patients was significantly positively correlated with SOFA score, APACHE II score, blood lactic acid (Lac), alanine aminotransferase (ALT) and NA dosage (r values were 0.572, 0.585, 0.463, 0.411, 0.696, all P < 0.05), and it significantly negatively correlated with MAP and oxygenation index (PaO2/FiO2; r values were -0.392 and -0.496, both P < 0.05). Multivariate Logistic regression analysis showed that plasma exosome count on the 1st day of ICU admission was an independent risk factor for 28-day death in septic patients [odds ratio (OR) = 1.385, 95% confidence interval (95%CI) was 1.075-1.785, P = 0.012]. ROC curve analysis showed that the area under the ROC curve (AUC) of plasma exosome count on the 1st day of ICU admission for predicting 28-day death in septic patients was 0.800 (95%CI was 0.449-1.000); when the optimal cut-off value was 14.50×1015/L, the sensitivity was 80.0% and the specificity was 100%. According to the optimal cut-off value of 1-day plasma exosome count, the patients were divided into two groups for Kaplan-Meier survival curve analysis, and the results showed that the cumulative survival rate of patients with plasma exosome count < 14.50×1015/L was significantly higher than that of patients with plasma exosome count ≥ 14.50×1015/L (Log-Rank test: χ 2 = 19.100, P < 0.001).

Conclusions: The plasma exosome count of septic patients is significantly increased on the 1st day of admission to the ICU, which is related to the severity, and can predict the risk of death at 28 days.

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Zhonghua wei zhong bing ji jiu yi xue
Zhonghua wei zhong bing ji jiu yi xue Medicine-Critical Care and Intensive Care Medicine
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