The role of soluble thrombomodulin in the risk stratification and prognosis evaluation of septic patients in the emergency department

Yin, Qin; Liu, Bo; Chen, Yun-Xia; Zhao, Yongmei; Li, Chunsheng

doi:10.1016/j.thromres.2013.08.011

Cited by 23 publications

(31 citation statements)

References 31 publications

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“…Thirteen studies [24, 27, 28, 30–31, 35–36, 38–39, 42–45] were conducted in Europe, eight [25–26, 29, 32–33, 37, 41, 46] were conducted in Asia, one [40] was conducted in America, and one [34] in was conducted in Australia. With one exception [45], all studies were published in English.…”

Section: Resultsmentioning

confidence: 99%

“…The most frequent source of sepsis was pulmonary infection. Three studies [26, 35, 37] were performed in EDs, one [38a] was performed in a hospital ward, and the remaining studies were performed in an ICU. With respect to admission category characteristics, three studies [25, 28, 33] involved only medical patients, two [34, 39] involved only surgical patients, and the remaining studies involved both medical and surgical patients.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies [39–46] evaluated PCT clearance. Follow-up periods differed across studies, including 28 days [25, 29–33], 30 days [26], ICU stays [24, 28] and in-hospital stays [27]. …”

Section: Resultsmentioning

confidence: 99%

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Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis

Liu¹,

Su²,

Han³

et al. 2015

PLoS ONE

150

130

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Procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. However, studies have produced conflicting results. The purpose of the present meta-analysis is to explore the diagnostic accuracy of a single PCT concentration and PCT non-clearance in predicting all-cause sepsis mortality. We searched PubMed, Embase, Web of Knowledge and the Cochrane Library. Articles written in English were included. A 2 × 2 contingency table was constructed based on all-cause mortality and PCT level or PCT non-clearance in septic patients. Two authors independently evaluated study eligibility and extracted data. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I 2 index to test heterogeneity. Twenty-three studies with 3,994 patients were included. An elevated PCT level was associated with a higher risk of death. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05–3.30) using a random-effects model (I 2 = 63.5%). The overall area under the summary receiver operator characteristic (SROC) curve was 0.77 (95% CI, 0.73–0.80), with a sensitivity and specificity of 0.76 (95% CI, 0.67–0.82) and 0.64 (95% CI, 0.52–0.74), respectively. There was significant evidence of heterogeneity for the PCT testing time (P = 0.020). Initial PCT values were of limited prognostic value in patients with sepsis. PCT non-clearance was a prognostic factor of death in patients with sepsis. The pooled RR was 3.05 (95% CI, 2.35–3.95) using a fixed-effects model (I 2 = 37.9%). The overall area under the SROC curve was 0.79 (95% CI, 0.75–0.83), with a sensitivity and specificity of 0.72 (95% CI, 0.58–0.82) and 0.77 (95% CI, 0.55–0.90), respectively. Elevated PCT concentrations and PCT non-clearance are strongly associated with all-cause mortality in septic patients. Further studies are needed to define the optimal cut-off point and the optimal definition of PCT non-clearance for accurate risk assessment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis

Liu¹,

Su²,

Han³

et al. 2015

PLoS ONE

150

130

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“…With damage to the endothelium, excessive shedding of endothelial-bound TM results in a marked rise in sTM concentrations [13,14]. Therefore, sTM is proposed to be a valuable marker of endothelial damage and associated with mortality in sepsis [1,15,16].…”

Section: Introductionmentioning

confidence: 99%

The role of biomarkers of endothelial activation in predicting morbidity and mortality in patients with severe sepsis and septic shock in intensive care: A prospective observational study

Fang

Shao

et al. 2018

Thrombosis Research

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Introduction: Endothelial dysfunction plays an essential role in the pathogenesis of sepsis. The study aimed to illustrate the associations between the dynamic change (from day 1 to day 7) in biomarker concentration of endothelial dysfunction and outcomes in severe sepsis and septic shock in the intensive care unit (ICU). Materials and methods:We studied 102 patients enrolled in the Beijing Chao-yang Hospital affiliated with the Capital Medical University. A receiver operating characteristic (ROC) curve were used to assess the prognostic values of the circulating adhesion Angiopoietin-2/Angiopoietin-1 ratio (Ang-2/Ang-1) and Angiopoietin-1/Tie-2 ratio (Ang-1/Tie-2), intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and thrombomodulin (TM). Spearman's rank correlation and a multiple regression analysis were used to assess the relationship between the change in sequential organ failure assessment (Δ SOFA) score (SOFA score at day 7 minus SOFA score at day 1) and the levels of Δ Ang-2/Ang-1 and Δ Ang-1/Tie-2 ratios, ΔsICAM-1, ΔsVCAM-1 and Δ sTM. Results: The Ang-2/Ang-1 ratio, sICAM-1, sVCAM-1 and sTM levels significantly increased from day 1 to day 7 (all p = 0.045), and the Ang-1/Tie-2 ratio level markedly decreased from day 1 and day 7 (p = 0.027) in nonsurvivors. The biomarkers at Days 1 and 7 had significant prognostic value for 90-day mortality in severe sepsis and septic shock in ICU. The difference in biomarkers for endothelial dysfunction were suggested to be effective, independent predictors of changes in Δ SOFA. Conclusions: Endothelial dysfunction may constitute an independent contributor to sepsis-associated outcomes in ICU. migrate into the surrounding tissue, and inflammation and coagulation pathways are activated. The key event underlying endothelial dysfunction is the massive response of the host to inflammatory mediators and pro-coagulant factors, contributing to endothelial injury, tissue hypoperfusion, disseminated intravascular coagulation and organ dysfunction [2].Abbreviations: Ang, angiopoietin; Tie-2, tyrosine kinase with immunoglobulin-like loop epidermal growth factor domain 2; Ang-2/Ang-1, Angiopoietin-2/ Angiopoietin-1 ratio; Ang-1/Tie-2, Angiopoietin-1/Tie-2 ratio; ICAM-1, intercellular adhesion molecule-1; VCAM-1, vascular cell adhesion molecule-1; TM, thrombomodulin; sICAM-1, soluble intercellular adhesion molecule-1; sVCAM-1, soluble vascular cell adhesion molecule-1; sTM, soluble thrombomodulin; ICU, intensive care unit; SOFA, sequential organ failure assessment; Δ SOFA score, SOFA score at day 7 minus SOFA score at day 1; Δ Ang-2/Ang-1 ratio, the level of Ang-2/Ang-1 ratio at day 7 minus the level of Ang-2/Ang-1 ratio at day 1; Δ Ang-1/Tie-2 ratio, the level of Ang-1/Tie-2 ratio at day 7 minus the level of Ang-1/Tie-2 ratio at day 1; Δ sICAM-1, the level of sICAM-1 at day 7 minus the level of sICAM-1 at day 1; Δ sVCAM-1, the level of sVCAM-1 at day 7 minus the level of sVCAM-1 at day 1; Δ sTM, the level of sTM at day 7 minus the level of sTM at day 1

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“…The most common criteria used were two SIRS criteria in combination with an infection, used by eight articles. [13][14][15][16][17][18][19][20] The second most used inclusion criterion was the 2001…”

Section: Resultsmentioning

confidence: 99%

Predicting mortality in patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review.

Tong‐Minh¹,

Welten²,

Endeman³

et al. 2020

Preprint

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Introduction Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED.Methods We performed a systematic search using MEDLINE, PubMed, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the diagnostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. Results We found 18 articles in this systematic review. In these 18 articles, a total of 35 combinations of biomarkers and clinical scoring systems were studied of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality. Conclusion In this systematic review, the combination of PCT, IL-6, lactate and the SAPS-2 score had the highest AUC on 1-month mortality in patients with sepsis in the ED. The studies we found in this review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis.

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The role of soluble thrombomodulin in the risk stratification and prognosis evaluation of septic patients in the emergency department

Cited by 23 publications

References 31 publications

Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis

Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis

The role of biomarkers of endothelial activation in predicting morbidity and mortality in patients with severe sepsis and septic shock in intensive care: A prospective observational study

Predicting mortality in patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review.

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