BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accu...BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accurate identification of AD patients with high risk of development of ACLF and mortality.Soluble triggering receptor expressed on myeloid cells-1(sTREM-1)is released from activated innate immune cells and correlated with various inflammatory processes.AIM To explore the prognostic value of sTREM-1 in patients with AD of cirrhosis.METHODS A multicenter prospective cohort of 442 patients with cirrhosis hospitalized for AD was divided into a study cohort(n=309)and validation cohort(n=133).Demographic and clinical data were collected,and serum sTREM-1 was measured at admission.All enrolled patients were followed-up for at least 1 year.RESULTS In patients with AD and cirrhosis,serum sTREM-1 was an independent prognosis predictor for 1-year survival and correlated with liver,coagulation,cerebral and kidney failure.A new prognostic model of AD(P-AD)incorporating sTREM-1,blood urea nitrogen(BUN),total bilirubin(TBil),international normalized ratio(INR)and hepatic encephalopathy grades was established and performed better than the model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-consortium(CLIF-C)ACLF and CLIF-C AD scores.Additionally,sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d follow-up.The ACLF risk score incorporating serum sTREM-1,BUN,INR,TBil and aspartate aminotransferase levels was established and significantly superior to MELD,MELD-Na,CLIF-C ACLF,CLIF-C AD and P-AD in predicting risk of ACLF development.CONCLUSION Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.展开更多
文摘目的探讨血清可溶性髓系细胞触发受体1(soluble triggering receptor expressed on myeloid cells 1,sTREM1)水平联合改良儿童早期预警评分(modified pediatric early warning score,MPEWS)对腺病毒肺炎(adenovirus pneumonia,AdVP)患儿病情及预后的评估价值。方法将2021年1月至2024年7月北京市顺义区医院收治的153例AdVP患儿(AdVP组)和同期50例健康儿童(对照组)纳入研究。将AdVP患儿根据病情程度分为重度AdVP组(60例)和轻度AdVP组(93例);根据28 d预后分为不良预后组(21例)和良好预后组(132例)。采用酶联免疫吸附法检测血清sTREM1水平,并计算MPEWS评分。通过多因素非条件Logistic回归分析血清sTREM1水平和MPEWS评分与AdVP患儿预后的关系,受试者工作特征曲线(receiver operating curve,ROC)分析血清sTREM1水平联合MPEWS评分对AdVP患儿病情及预后的评估价值。结果与对照组比较,AdVP组血清sTREM1水平升高(P<0.05)。与轻度AdVP组比较,重度AdVP组血清sTREM1水平和MPEWS评分均升高(P均<0.05)。AdVP组患儿不良预后率为13.73%(21/153)。与良好预后组比较,不良预后组血清sTREM1水平和MPEWS评分均升高(P均<0.05)。重度AdVP、sTREM1高、MPEWS评分高为AdVP患儿不良预后的独立危险因素(P均<0.05)。血清sTREM1水平联合MPEWS评分评估重度AdVP的曲线下面积(area under the curve,AUC)为0.904,大于血清sTREM1水平、MPEWS评分单独评估的AUC(0.777、0.815)(P均<0.05);血清sTREM1水平联合MPEWS评分评估AdVP患儿不良预后的AUC为0.947,大于血清sTREM1水平、MPEWS评分单独评估的AUC(0.811、0.875)(P均<0.05)。结论AdVP患儿血清sTREM1水平和MPEWS评分升高与病情加重、不良预后有关,血清sTREM1水平联合MPEWS评分评估AdVP患儿病情及预后的价值较高。
基金National Natural Science Foundation of China,No.81970550,No.82070613 and No.82370638Natural Science Foundation of Hunan Province,China,No.2021JJ31067 and No.2021JJ41048+1 种基金Hunan innovative province construction project,No.2023JJ10095Innovative Talented Project of Hunan province,China,No.2022RC1212.
文摘BACKGROUND Acute decompensation(AD)of cirrhosis is associated with high short-term mortality,mainly due to the development of acute-on-chronic liver failure(ACLF).Thus,there is a need for biomarkers for early and accurate identification of AD patients with high risk of development of ACLF and mortality.Soluble triggering receptor expressed on myeloid cells-1(sTREM-1)is released from activated innate immune cells and correlated with various inflammatory processes.AIM To explore the prognostic value of sTREM-1 in patients with AD of cirrhosis.METHODS A multicenter prospective cohort of 442 patients with cirrhosis hospitalized for AD was divided into a study cohort(n=309)and validation cohort(n=133).Demographic and clinical data were collected,and serum sTREM-1 was measured at admission.All enrolled patients were followed-up for at least 1 year.RESULTS In patients with AD and cirrhosis,serum sTREM-1 was an independent prognosis predictor for 1-year survival and correlated with liver,coagulation,cerebral and kidney failure.A new prognostic model of AD(P-AD)incorporating sTREM-1,blood urea nitrogen(BUN),total bilirubin(TBil),international normalized ratio(INR)and hepatic encephalopathy grades was established and performed better than the model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-consortium(CLIF-C)ACLF and CLIF-C AD scores.Additionally,sTREM-1 was increased in ACLF and predicted the development of ACLF during first 28-d follow-up.The ACLF risk score incorporating serum sTREM-1,BUN,INR,TBil and aspartate aminotransferase levels was established and significantly superior to MELD,MELD-Na,CLIF-C ACLF,CLIF-C AD and P-AD in predicting risk of ACLF development.CONCLUSION Serum sTREM-1 is a promising prognostic biomarker for ACLF development and mortality in patients with AD of cirrhosis.
