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Impact Factor 3.434摘要 目的 本研究探讨了血清中组织型纤溶酶原激活物抑制剂复合物（t-PAIC）水平是否能早期预测脓毒症休克。 Background. Sepsis can progress to septic shock and death, and identifying biomarkers of this progression may permit timely intervention to prevent it. This study explored whether levels of tissue-type plasminogen activator-inhibitor complex (t-PAIC) in serum can predict septic shock early. 方法 我们回顾性分析了在2018年5月至2021年4月期间在我院三级医院接受ICU治疗的311例脓毒症患者，并分为203例脓毒症休克与108例非脓毒症休克两组患者（基于SEPSIS-3定义）。在根据倾向评分对两组患者进行匹配后，我们使用logistic回归筛选感染性休克的危险因素。我们根据受试者工作特征曲线（AUC）下面积、Kaplan-Meier生存曲线和相关分析来评估感染性休克的潜在预测因素。 Methods. We retrospectively analyzed 311 sepsis patients who had been admitted to the intensive care unit (ICU) at our tertiary care hospital between May 2018 and April 2021, and we divided them into those who progressed to septic shock (n=203) or not (n=108) based on sepsis-3 definition. After matching patients in the two groups based on propensity scoring, we screened for risk factors of septic shock using logistic regression. We assessed potential predictors of such shock based on the area under the receiver-operating characteristic curve (AUC), Kaplan-Meier survival curves, and correlation analysis. 结果 在倾向评分匹配后，我们发现感染性休克患者的血清t-PAIC显著高于非感染性休克患者。单因素和多因素logistic回归分析表明，t-PAIC是感染性休克的独立危险因素（OR 1.14, 95% CI 1.09–1.19, P < 0.001)，其评价感染性休克的AUC高达0.875（95% CI, 0.829-0.920）。基于最佳阈值17.9ng/ml，我们发现处于或高于该阈值的脓毒症患者在急性生理学和慢性健康评估II（APACHE II）和序贯器官衰竭评估（SOFA）中的乳酸水平和得分显著较高。这些患者的生存率也显著降低（HR 2.4, 95% CI 1.38–4.34, P = 0.004）。Spearman的相关系数在t-PAIC和乳酸之间为0.66，在t-PAIC和SOFA之间为0.52。 Results. After propensity score matching to generate two equal groups of 108 patients, we found that serum t-PAIC was significantly higher in septic shock patients. Uni- and multivariate logistic regression identified t-PAIC as an independent risk factor for septic shock (OR 1.14, 95% CI 1.09–1.19, P < 0.001) and a biomarker that predicted it with an AUC up to 0.875(95% CI, 0.829-0.920). Based on the optimal cut-off oft‐PAIC = 17:9 ng/mL, we found that patients at or above this threshold had significantly higher lactate levels and scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA). Such patients also had significantly worse survival (HR 2.4, 95% CI 1.38–4.34, P = 0.004）. Spearman’s correlation coefficients were 0.66 between t-PAIC and lactate, and 0.52 between t-PAIC and SOFA. 结论 血清t-PAIC水平可能是脓毒症休克的独立危险因素，并与脓毒症休克的严重程度相关。 Conclusions. Serum levels of t-PAIC may be an independent risk factor for septic shock, and they may correlate with the severity of such shock.
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