CRRT重症肺部感染相关脓毒症患者HMGB1、sFLT-1、LAR水平与28 d临床结局的关系

Correlation of HMGB1, sFLT-1 and LAR levels with 28-day clinical outcomes in patients with severe pulmonary infection-associated sepsis undergoing CRRT

    摘要
  • 摘要:
    目的 探究连续性肾脏替代治疗(CRRT)重症肺部感染相关性脓毒症患者高迁移率族蛋白B1(HMGB1)、可溶性血管内皮生长因子受体1(sFLT-1)、乳酸/白蛋白比值(LAR)水平，及各指标与患者28 d临床结局的关系。
    方法 选择2021年7月-2024年7月重庆市南川区人民医院CRRT重症肺部感染相关脓毒症患者102例为研究对象，依据患者28 d临床结局将其分为良好预后组(71例)和不良预后组(31例)。比较两组HMGB1、sFLT-1、乳酸、白蛋白、LAR水平，采用受试者工作特征(ROC)曲线分析HMGB1、sFLT-1、LAR对CRRT重症肺部感染相关性脓毒症患者28 d临床结局的预测价值。
    结果 CRRT重症肺部感染相关性脓毒症患者病原菌以革兰阴性菌为主，不良预后组乳酸水平为(4.01±1.07)mmol/L，高于良好预后组，白蛋白水平为(27.46±4.15)g/L，低于良好预后组(P < 0.05)。不良预后组HMGB1、sFLT-1、LAR水平分别为(62.66±15.66)ng/ml、(0.71±0.17)ng/ml、(14.59±3.64)%，高于良好预后组(P < 0.05)。HMGB1、sFLT-1、LAR对CRRT联合检测预测重症肺部感染相关性脓毒症患者28 d预后不良的曲线下面积(AUC)为0.949，大于各指标单独检测(P < 0.05)，且联合检测的敏感度、特异度为93.55%、87.32%。
    结论 CRRT重症肺部感染相关性脓毒症患者病原菌以革兰阴性菌为主，不良预后患者HMGB1、sFLT-1、LAR表达异常增加，且三者联合检测对其28 d死亡临床结局预测价值较高。

     

    Abstract:
    OBJECTIVE To investigate the levels of high-mobility group box 1 (HMGB1) protein, soluble fms-like tyrosine kinase 1 (sFLT-1) and lactate-to-albumin ratio (LAR) in patients with severe pulmonary infection-associated sepsis undergoing continuous renal replacement therapy (CRRT), and their correlation with 28-day clinical outcomes.
    METHODS A total of 102 patients with severe pulmonary infection-associated sepsis undergoing CRRT admitted to the People's Hospital of Nanchuan Chongqing from Jul. 2021 to Jul. 2024 were enrolled. Based on 28-day clinical outcomes, they were divided into a favorable prognosis group (71 cases) and a poor prognosis group (31 cases). The levels of HMGB1, sFLT-1, lactate, albumin and LAR were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of HMGB1, sFLT-1 and LAR for 28-day clinical outcomes in patients with severe pulmonary infection-associated sepsis undergoing CRRT.
    RESULTS Gram-negative bacteria were the predominant pathogens in patients with severe pulmonary infection-associated sepsis undergoing CRRT. The poor prognosis group had higher lactate levels (4.01±1.07 mmol/L) and lower albumin levels (27.46±4.15 g/L) than the favorable prognosis group (P < 0.05). The levels of HMGB1 (62.66±15.66 ng/ml), sFLT-1 (0.71±0.17 ng/ml) and LAR (14.59±3.64%) in the poor prognosis group were significantly higher than those in the favorable prognosis group (P < 0.05). The combined detection of HMGB1, sFLT-1 and LAR yielded an area under the curve (AUC) of 0.949 for predicting poor 28-day mortality in patients with severe pulmonary infection-associated sepsis undergoing CRRT, superior to the single detection of the indexes (P < 0.05), with a sensitivity of 93.55% and specificity of 87.32%.
    CONCLUSIONS In patients with severe pulmonary infection-associated sepsis undergoing CRRT, gram-negative bacteria are the predominant pathogens. Patients with poor prognosis exhibit abnormally elevated levels of HMGB1, sFLT-1 and LAR, and the combined detection of these three markers demonstrates high predictive value for 28-day mortality.

     

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