CC:脓毒症患者早期高敏感肌钙蛋白升高与短期死亡率：一项meta分析的系统综述

Abstract

Background: Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical significance of this phenomenon with high-sensitivity (hs) assays and the current sepsis definition needs to be settled.

背景：血清心脏肌钙蛋白（cTn）升高是脓毒症中一个公认的现象。然而，在使用高灵敏度（hs）检测方法以及当前脓毒症定义下，这一现象的临床意义仍需进一步明确。

Research question: What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients?

研究问题：通过高灵敏度检测方法测量的早期血清cTn水平与脓毒症患者短期死亡风险之间有何关联？

Study design and methods: We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 definition. For the synthesis of the effect of hs-cTn on mortality, we applied random effect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean difference (SMD) of hs-cTn between survivors and non-survivors.

研究设计与方法：我们通过PubMed、Scopus和Embase数据库进行了系统性文献检索。纳入标准为报告了符合Sepsis-3定义的成人脓毒症患者中早期hs-cTn水平与死亡风险关联数据的研究。为了综合分析hs-cTn对死亡风险的影响，我们对未调整和调整后的比值比（分别为OR和aOR）进行了随机效应模型分析，比较了hs-cTn升高与正常血清值的情况，并对生存者与非生存者之间的hs-cTn粗标准化均数差（SMD）进行了分析。

Results: In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41-1.33). Elevated hs-cTn was associated with increased mortality (OR = 1.78, 95% CI: 1.41-2.25). However, this prognostic effect was absent in studies that adjusted for different confounders (aOR = 1.06, 95% CI: 0.99-1.14).

结果：共纳入17项研究中的6242名患者，短期死亡率范围为16.9%至53.8%。在未调整的分析中，非生存者的hs-cTn水平显著高于生存者（SMD为0.87，95%CI：0.41-1.33）。hs-cTn升高与死亡风险增加相关（OR = 1.78，95%CI：1.41-2.25）。然而，在调整了不同混杂因素的研究中，这种预后效应消失（aOR = 1.06，95%CI：0.99-1.14）。

Discussion and conclusions: Non-survivors of sepsis exhibited significantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis.

讨论与结论：脓毒症非生存者的hs-cTn水平显著升高。尽管hs-cTn升高与死亡风险增加相关，但在脓毒症中，hs-cTn升高并非这一结果的独立预测因素。