内皮病被认为是败血症和创伤相关器官衰竭的关键病理生理学。但其在急性呼吸衰竭中的作用尚未确定。我们调查了ICU入院时内皮病生物标志物是否与需要机械通气的急性呼吸衰竭患者的疾病严重程度和临床结局相关。
我们进行了一项前瞻性单中心队列研究,包括459名在ICU入院时机械通气的成年人。在ICU入院时测量三种内皮病生物标志物的血浆水平:Syndecan-1,可溶性血栓调节蛋白(sTM),和血小板内皮细胞粘附分子-1(PECAM-1)。主要结果是机械通气的解放率,与仍在机械通气时的竞争死亡风险率一起呈现。次要结果是在5天内死亡的患者入院时和最后一次测量时的PaO2/FiO2比值。和30天全因死亡率。使用Cox回归分析主要结局和30天全因死亡率,受性别控制,年龄,慢性阻塞性肺疾病,感染性休克,心力衰竭,入院时PaO2/FiO2比值,呼吸道感染,急性肾损伤,和胆红素.PaO2/FiO2比值采用线性回归分析,控制年龄,慢性阻塞性肺疾病,呼吸道感染,和震惊。
高sTM患者以较低的速率从机械通气中释放(调整后的危险比(HR)0.71,从第25百分位数增加到第75百分位数,95%置信区间(CI)0.54-0.93,p=0.01)。高PECAM-1的患者以较低的速度从机械通气中解放出来,但仅限于前5天(调整后的HR0.72,从第25百分位数增加到第75百分位数,95%CI0.58-0.9,p<0.01)。在机械通气时,高水平的Syndecan-1和PECAM-1与较高的死亡率相关。sTM和PECAM-1与ICU入院时的PaO2/FiO2比值呈负相关,没有生物标志物与上次测量的PaO2/FiO2比值相关。高水平的所有生物标志物与更高的30天全因死亡率相关。
在急性呼吸衰竭中,内皮病生物标志物与较低的机械通气释放率相关,ICU入院时低氧血症,和30天全因死亡率。
Endotheliopathy is suggested as pivotal pathophysiology of sepsis and trauma-associated organ failure, but its role in acute respiratory failure is not yet determined. We investigated if endotheliopathy biomarkers at ICU admission are associated with illness severity and clinical outcomes in patients with acute respiratory failure requiring mechanical ventilation.
We conducted a prospective single-center cohort
study including 459 mechanically ventilated adults at ICU admission. Plasma levels of three endotheliopathy biomarkers were measured at ICU admission: Syndecan-1, soluble Thrombomodulin (sTM), and Platelet Endothelial Cell Adhesion Molecule-1 (PECAM-1). The primary outcome was the rate of liberation from mechanical ventilation, which is presented together with the rate of the competing risk of death while still on mechanical ventilation. Secondary outcomes were PaO2/FiO2-ratios on admission and on last measurement in patients dying within five days, and 30-day all-cause mortality. The primary outcome and 30-day all-cause mortality were analyzed using Cox regression, controlled for gender, age, chronic obstructive pulmonary disease, septic shock, heart failure, PaO2/FiO2-ratio at admission, respiratory infection, acute kidney injury, and bilirubin. PaO2/FiO2-ratios were analyzed using linear regression, controlled for age, chronic obstructive pulmonary disease, respiratory infection, and shock.
Patients with high sTM were liberated from mechanical ventilation at a lower rate (adjusted hazard ratio (HR) 0.71, for an increase from the 25th to the 75th percentile, 95% confidence interval (CI) 0.54-0.93, p = 0.01). Patients with high PECAM-1 were liberated from mechanical ventilation at a lower rate, but only during the first 5 days (adjusted HR 0.72, for an increase from the 25th to the 75th percentile, 95% CI 0.58-0.9, p < 0.01). High levels of Syndecan-1 and PECAM-1 were associated with a higher rate of death while still on mechanical ventilation. sTM and PECAM-1 were negatively associated with PaO2/FiO2-ratio at ICU admission and no biomarker was associated with last measured PaO2/FiO2-ratio. High levels of all biomarkers were associated with higher 30-day all-cause mortality.
In acute respiratory failure, endotheliopathy biomarkers are associated with lower rates of liberation from mechanical ventilation, hypoxemia at ICU admission, and 30-day all-cause mortality.