• Am J Emerg Med · Jan 2018

    The risk stratification and prognostic evaluation of soluble programmed death-1 on patients with sepsis in emergency department.

    • Yongzhen Zhao, Yumei Jia, Chunsheng Li, Yingying Fang, and Rui Shao.
    • Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Cardiopulmonary-Cerebral Resuscitation, Beijing Chaoyang Hospital, Capital Medical University, Beijing,China.
    • Am J Emerg Med. 2018 Jan 1; 36 (1): 43-48.

    ObjectiveTo evaluate the efficacy of soluble programmed death-1 (sPD-1) for risk stratification and prediction of 28-day mortality in patients with sepsis, we compared serum sPD-1 with procalcitonin (PCT), C-reactive protein (CRP), and the Mortality in Emergency Department Sepsis (MEDS) score.MethodsA total of 60 healthy volunteers and 595 emergency department (ED) patients were recruited for this prospective cohort study. According to the severity of their condition on ED arrival, the patients were allocated to the systemic inflammatory response syndrome group (130 cases), sepsis group (276 cases), severe sepsis group (121 cases), and septic shock group (68 cases). In addition, all patients with sepsis were also divided into the survivor group (349 cases) and nonsurvivor group (116 cases) according to the 28-day outcomes.ResultsWhen the severity of sepsis increased, the levels of sPD-1 gradually increased. The levels of sPD-1, PCT, CRP and the MEDS score were also higher in the nonsurvivor group compared to the survivor group. Logistic regression suggested that sPD-1, PCT, and the MEDS score were independent risk factors for 28-day mortality of patients with sepsis. Area under the curve (AUC) of sPD-1, PCT and the MEDS score for 28-day mortality was 0.725, 0.693, and 0.767, respectively, and the AUC was improved when all 3 factors were combined (0.843).ConclusionSerum sPD-1 is positively correlated with the severity of sepsis, and it is valuable for risk stratification of patients and prediction of 28-day mortality. Combining sPD-1 with PCT and the MEDS score improves the prognostic evaluation.Copyright © 2017 Elsevier Inc. All rights reserved.

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