脓毒症患者血浆辛迪加-1和不同微循环参数的动态变化及预后价值：前瞻性观察研究

IF 2.3 3区医学 Q2 SURGERY

World Journal of Surgery Pub Date : 2025-02-01 Epub Date: 2024-12-16 DOI:10.1002/wjs.12452

Xiayan Qian, Ka Yin Lui, Xiaoguang Hu, Shuhe Li, Xiaodong Song, Changcheng Lin, Yujun Liang, Xiangdong Guan, Changjie Cai

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Additionally, capillary refill time and serum lactate levels were recorded. The primary outcome was 30-day mortality.Results: Of the 74 patients enrolled, the 30-day mortality rate was 35.1%. Significantly, higher syndecan-1 levels were observed in nonsurvivors at baseline, day 1, and day 2 (62.43 [37.37 and 103.16] vs. 97.24 [52.95 and 186.40] ng/mL and p = 0.035; 62.22 [41.50 and 87.52] vs. 96.71 [60.82 and 176.00] ng/mL and p = 0.009; and 56.03 [39.16 and 94.48] vs. 87.69 [72.52 and 159.70] ng/mL and p = 0.005, respectively). High syndecan-1 levels (≥121 ng/mL) were associated with lower survival rates (p = 0.001) and an increase exceeding 8 ng/mL within 2 days indicated a higher mortality risk (p = 0.0075). 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引用次数: 0

摘要

背景：糖萼降解与脓毒症的内皮损伤和微循环功能障碍有关，而血浆辛迪加-1水平和舌下微循环参数在评估脓毒症预后方面的有效性尚未确定。本研究旨在追踪它们的动态变化，并探讨这些指标在脓毒症预后中的作用：在中山大学附属第一医院进行的这项前瞻性研究中，采集了成人外科脓毒症患者入院后 2 天内的血液样本，测量血浆辛迪加-1 的浓度。同时还采集了相关的舌下微循环参数。此外，还记录了毛细血管再充盈时间和血清乳酸水平。主要结果是 30 天死亡率：结果：在入组的 74 名患者中，30 天死亡率为 35.1%。在基线、第 1 天和第 2 天，非幸存者的辛迪加-1 水平明显更高（62.43 [37.37 和 103.16] vs. 97.24 [52.95 和 186.40] ng/mL，p = 0.035; 62.22 [41.50 and 87.52] vs. 96.71 [60.82 and 176.00] ng/mL and p = 0.009; and 56.03 [39.16 and 94.48] vs. 87.69 [72.52 and 159.70] ng/mL and p = 0.005)。高辛迪加-1水平（≥121纳克/毫升）与较低的存活率相关（p = 0.001），2天内增加超过8纳克/毫升表明死亡率风险较高（p = 0.0075）。辛迪加-1水平显示出令人满意的预后能力（AUC：0.7056），而结合辛迪加-1和血乳酸则显示出对30天生存率的最高预测能力（AUC：0.7726）：结论：血浆辛迪加-1水平能有效预测脓毒症的预后，基线水平越高或呈上升趋势表明预后越差。结论：血浆辛迪加-1水平可有效预测脓毒症预后，基线水平越高或呈上升趋势表明预后越差。将辛迪加-1与血乳酸结合可提高脓毒症患者30天死亡率的预测准确性：本研究于2021年12月31日在中国临床试验注册中心注册（ChiCTR2100055066）。

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Dynamic changes and prognosis value of plasma syndecan-1 and different microcirculatory parameters in sepsis: A prospective observational study.

Background: Glycocalyx degradation is implicated in endothelial damage and microcirculatory dysfunction in sepsis, whereas the effectiveness of plasma syndecan-1 levels and sublingual microcirculatory parameters in evaluating sepsis's prognosis has not yet been determined. This study aims to track their dynamic changes and investigate the prognostic utility of these indexes in sepsis.

Methods: In this prospective study conducted at the First Affiliated Hospital of Sun Yat-sen University, blood samples were collected from adult surgical septic patients within 2 days after intensive care unit admission measuring plasma syndecan-1 concentrations. Relevant sublingual microcirculatory parameters were also obtained simultaneously. Additionally, capillary refill time and serum lactate levels were recorded. The primary outcome was 30-day mortality.

Results: Of the 74 patients enrolled, the 30-day mortality rate was 35.1%. Significantly, higher syndecan-1 levels were observed in nonsurvivors at baseline, day 1, and day 2 (62.43 [37.37 and 103.16] vs. 97.24 [52.95 and 186.40] ng/mL and p = 0.035; 62.22 [41.50 and 87.52] vs. 96.71 [60.82 and 176.00] ng/mL and p = 0.009; and 56.03 [39.16 and 94.48] vs. 87.69 [72.52 and 159.70] ng/mL and p = 0.005, respectively). High syndecan-1 levels (≥121 ng/mL) were associated with lower survival rates (p = 0.001) and an increase exceeding 8 ng/mL within 2 days indicated a higher mortality risk (p = 0.0075). Syndecan-1 levels displayed satisfactory prognostic capability (AUC: 0.7056), whereas combining syndecan-1 and blood lactate demonstrated the highest predictive ability for 30-day survival (AUC: 0.7726).

Conclusions: Plasma syndecan-1 levels effectively predict sepsis prognosis, with higher baseline levels or increasing trends indicating worse outcomes. Combining syndecan-1 with blood lactate enhances predictive accuracy for 30-day mortality in sepsis.

Trial registration: This study registered in China on December 31, 2021 at Chinese Clinical Trial Registry (ChiCTR2100055066).

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来源期刊

World Journal of Surgery 医学-外科

CiteScore

5.10

自引率

3.80%

发文量

460

审稿时长

3 months

期刊介绍： World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board.