使用二肽基肽酶-3 和肾素（SPiDeR）对 COVID-19 低氧血症患者进行休克预测。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-11-14 DOI:10.1016/j.jcrc.2024.154950

Laurence W. Busse MD, MBA, FCCM , J. Pedro Teixeira MD , Christopher L. Schaich PhD , Caitlin C. ten Lohuis ACNP-BC , Nathan D. Nielsen MD, MSc , Jeffrey M. Sturek MD, PhD , Lisa H. Merck MD, MPH , Wesley H. Self MD, MPH , Michael A. Puskarich MD, MSCR , Akram Khan MBBS , Matthew W. Semler MD, MSc , Ari Moskowitz MD, MPH , David N. Hager MD, PhD , Abhijit Duggal MD, MPH, MSc , Todd W. Rice MD, MSc , Adit A. Ginde MD, MPH , Brian R. Tiffany MD, PhD , Nicole M. Iovine MD , Peter Chen MD , Basmah Safdar MD, MSc , Sean P. Collins MD, MSc

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引用次数: 0

摘要

背景：血浆二肽基肽酶-3（DPP3）和肾素水平与器官功能障碍和死亡率有关。然而，这些生物标志物是否与高危患者随后发生休克有关尚不清楚：我们使用从参加第四次加速 COVID-19 治疗干预和疫苗宿主组织平台试验的参与者处收集的血浆样本，测量了 184 名因 COVID-19 急性低氧血症住院且无基线血管加压需求的受试者的 DPP3 和肾素。我们根据第 0 天的 DPP3 和肾素水平计算了第 28 天发生休克（定义为开始使用血管加压疗法）的几率：结果：DPP3高于中位数的受试者在28天内启动血管加压疗法的发生率明显更高（28.4% vs. 16.7%，p = 0.031），28天死亡率也更高（25.0% vs. 6.7%，p 结论：DPP3高于中位数的受试者在28天内启动血管加压疗法的发生率明显更高（28.4% vs. 16.7%，p = 0.031），28天死亡率也更高（25.0% vs. 6.7%，p = 0.031）：在因 COVID-19 和低氧血症住院但无基线低血压的患者中，DPP3（而非肾素）的基线血浆水平越高，随后发生休克和死亡的风险就越高。

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Shock prediction with dipeptidyl peptidase-3 and renin (SPiDeR) in hypoxemic patients with COVID-19

Background

Plasma dipeptidyl peptidase-3 (DPP3) and renin levels are associated with organ dysfunction and mortality. However, whether these biomarkers are associated with the subsequent onset of shock in at-risk patients is unknown.

Methods

Using plasma samples collected from participants enrolled in the fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines Host Tissue platform trial, we measured DPP3 and renin in 184 subjects hospitalized with acute hypoxemia from COVID-19 without baseline vasopressor requirement. We calculated the odds ratio of development of shock (defined as the initiation of vasopressor therapy) by Day 28 based on Day 0 DPP3 and renin levels.

Results

Subjects with DPP3 above the median had a significantly higher incidence of vasopressor initiation within 28 days (28.4 % vs. 16.7 %, p = 0.031) and higher 28-day mortality (25.0 % vs. 6.7 %, p < 0.001). After adjusting for covariables, DPP3 above the median was associated with shorter time to vasopressor initiation, greater 28-day mortality, fewer vasopressor-free days, and greater odds of a hypotensive event over 7 days. Significant associations were not observed for renin.

Conclusions

In patients hospitalized with COVID-19 and hypoxemia without baseline hypotension, higher baseline plasma levels of DPP3 but not renin were associated with increased risk of subsequent shock and death.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.