{"id":17824,"date":"2019-11-09T05:11:00","date_gmt":"2019-11-08T21:11:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17824"},"modified":"2019-12-12T07:12:06","modified_gmt":"2019-12-11T23:12:06","slug":"jama-network-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-%e8%84%93%e6%af%92%e7%97%87%e6%82%a3%e8%80%85%e9%95%bf%e6%9c%9f%e5%ae%bf%e4%b8%bb%e5%85%8d%e7%96%ab%e5%8f%8d%e5%ba%94%e6%94%b9%e5%8f%98","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17824","title":{"rendered":"[JAMA Network Open\u53d1\u8868\u8bba\u6587]: \u8113\u6bd2\u75c7\u60a3\u8005\u957f\u671f\u5bbf\u4e3b\u514d\u75ab\u53cd\u5e94\u6539\u53d8"},"content":{"rendered":"\n

Original Investigation Critical Care MedicineAugust 7, 2019<\/p>\n\n\n\n

Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis<\/h1>\n\n\n\n

Sachin Yende, John A. Kellum, Victor B. Talisa, et al<\/h3>\n\n\n\n

JAMA Netw Open. <\/em>2019;2(8):e198686. doi:10.1001\/jamanetworkopen.2019.8686<\/h3>\n\n\n\n

Importance<\/strong>\u00a0\u80cc\u666f<\/h3>\n\n\n\n

Long-term immune sequelae after sepsis are poorly understood.<\/p>\n\n\n\n

\u8113\u6bd2\u75c7\u540e\u957f\u671f\u514d\u75ab\u540e\u9057\u75c7\u5c1a\u672a\u660e\u786e\u3002<\/p>\n\n\n\n

Objective<\/strong>\u00a0\u76ee\u7684<\/h3>\n\n\n\n

To assess whether abnormalities in the host immune response during hospitalization for sepsis persist after discharge.<\/p>\n\n\n\n

\u8bc4\u4ef7\u8113\u6bd2\u75c7\u60a3\u8005\u4f4f\u9662\u671f\u95f4\u7684\u5f02\u5e38\u5bbf\u4e3b\u514d\u75ab\u53cd\u5e94\u662f\u5426\u6301\u7eed\u5230\u51fa\u9662\u540e\u3002<\/p>\n\n\n\n

Design, Settings, and Participants<\/strong>\u00a0\u8bd5\u9a8c\u8bbe\u8ba1\uff0c\u573a\u666f\u548c\u7814\u7a76\u4eba\u7fa4<\/h3>\n\n\n\n

This prospective, multicenter cohort study enrolled and followed up for 1 year adults who survived a hospitalization for sepsis from January 10, 2012, to May 25, 2017, at 12 US hospitals.<\/p>\n\n\n\n

\u8fd9\u9879\u524d\u77bb\u591a\u4e2d\u5fc3\u961f\u5217\u7814\u7a76\u4ece2012\u5e741\u670810\u65e5\u81f32017\u5e745\u670825\u65e5\u5728\u7f8e\u56fd12\u6240\u533b\u9662\u8fdb\u884c\u3002\u7814\u7a76\u7eb3\u5165\u5b58\u6d3b\u7684\u6210\u5e74\u8113\u6bd2\u75c7\u60a3\u8005\uff0c\u5e76\u968f\u8bbf1\u5e74\u3002<\/p>\n\n\n\n

Exposures<\/strong>\u00a0\u66b4\u9732\u56e0\u7d20<\/h3>\n\n\n\n

Circulating levels of inflammation (interleukin 6 and high-sensitivity C-reactive protein [hs-CRP]), immunosuppression (soluble programmed death ligand 1 [sPD-L1]), hemostasis (plasminogen activator inhibitor 1 and D-dimer), endothelial dysfunction (E-selectin, intercellular adhesion molecule 1, and vascular cell adhesion molecule 1), and oxidative stress biomarkers were measured at 5 time points during and after hospitalization for sepsis for 1 year. Individual biomarker trajectories and patterns of trajectories across biomarkers (phenotypes) were identified.<\/p>\n\n\n\n

\u5728\u56e0\u8113\u6bd2\u75c7\u4f4f\u9662\u671f\u95f4\u53ca\u51fa\u9662\u540e1\u5e74\u51855\u4e2a\u65f6\u95f4\u70b9\uff0c\u6d4b\u5b9a\u5faa\u73af\u4e2d\u708e\u75c7(IL-6, hsCRP)\uff0c\u514d\u75ab\u529f\u80fd\u6291\u5236(sPD-L1)\uff0c\u6b62\u8840(PAI-1, D-dimer)\uff0c\u5185\u76ae\u529f\u80fd\u969c\u788d(E-\u9009\u62e9\u7d20, ICAM-1, VCAM-1)\u53ca\u6c27\u5316\u5e94\u6fc0\u751f\u7269\u6807\u5fd7\u7269\u3002\u9274\u522b\u6bcf\u4e2a\u751f\u7269\u6807\u5fd7\u7269\u53ca\u4e0d\u540c\u751f\u7269\u6807\u5fd7\u7269\u7684\u53d8\u5316\u7279\u5f81\uff08\u8868\u578b\uff09\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>\u00a0\u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

Outcomes were adjudicated centrally and included all-cause and cause-specific readmissions and mortality.<\/p>\n\n\n\n

\u4e34\u5e8a\u7ed3\u5c40\u8fdb\u884c\u7edf\u4e00\u5224\u65ad\uff0c\u5305\u62ec\u5168\u56e0\u53ca\u75c5\u56e0\u7279\u5f02\u6027\u518d\u5165\u9662\u53ca\u6b7b\u4ea1\u3002<\/p>\n\n\n\n

Results<\/strong>\u00a0\u7ed3\u679c<\/h3>\n\n\n\n

A total of 483 patients (mean [SD] age, 60.5 [15.2] years; 265 [54.9%] male) who survived hospitalization for sepsis were included in the study. A total of 376 patients (77.8%) had at least 1 chronic disease, and their mean (SD) Sequential Organ Failure Assessment score was 4.2 (3.0). Readmissions were common (485 readmissions in 205 patients [42.5%]), and 43 patients (8.9%) died by 3 months, 56 patients (11.6%) died by 6 months, and 85 patients (17.6%) died by 12 months. Elevated hs-CRP levels were observed in 23 patients (25.8%) at 3 months, 26 patients (30.2%) at 6 months, and 23 patients (25.6%) at 12 months, and elevated sPD-L1 levels were observed in 45 patients (46.4%) at 3 months, 40 patients (44.9%) at 6 months, and 44 patients (49.4%) at 12 months. Two common phenotypes were identified based on hs-CRP and sPDL1 trajectories: high hs-CRP and sPDL1 levels (hyperinflammation and immunosuppression phenotype [326 of 477 (68.3%)]) and normal hs-CRP and sPDL1 levels (normal phenotype [143 of 477 (30.0%)]). These phenotypes had similar clinical characteristics and clinical course during hospitalization for sepsis. Compared with normal phenotype, those with the hyperinflammation and immunosuppression phenotype had higher 1-year mortality (odds ratio, 8.26; 95% CI, 3.45-21.69;\u00a0P<\/em>\u2009<\u2009.001), 6-month all-cause readmission or mortality (hazard ratio [HR], 1.53; 95% CI, 1.10-2.13;\u00a0P<\/em>\u2009=\u2009.01), and 6-month readmission or mortality attributable to cardiovascular disease (HR, 5.07; 95% CI, 1.18-21.84;\u00a0P<\/em>\u2009=\u2009.02) or cancer (HR, 5.15; 95% CI, 1.25-21.18;\u00a0P<\/em>\u2009=\u2009.02). These associations were adjusted for demographic characteristics, chronic diseases, illness severity, organ support, and infection site during sepsis hospitalization and were robust in sensitivity analyses.<\/p>\n\n\n\n

\u5171\u6709483\u540d\u8113\u6bd2\u75c7\u60a3\u8005 (\u5e73\u5747 [SD] \u5e74\u9f84, 60.5 [15.2] \u5c81; 265\u540d [54.9%] \u7537\u6027) \u5728\u4f4f\u9662\u671f\u95f4\u5b58\u6d3b\uff0c\u8fd9\u4e9b\u60a3\u8005\u7eb3\u5165\u672c\u7814\u7a76\u3002\u5171\u6709 376 \u540d\u60a3\u8005 (77.8%) \u81f3\u5c11\u6709\u4e00\u79cd\u6162\u6027\u5462\u75be\u75c5\uff0c\u5e73\u5747 (SD)SOFA\u8bc4\u5206 4.2 (3.0)\u3002\u518d\u5165\u9662\u975e\u5e38\u666e\u904d (205\u540d[42.5%]\u60a3\u8005485\u6b21\u518d\u5165\u9662)\uff0c3\u4e2a\u6708\u65f643\u540d(8.9%)\u60a3\u8005\u6b7b\u4ea1\uff0c5\u4e2a\u6708\u65f656\u540d(11.6%)\u60a3\u8005\u6b7b\u4ea1\uff0c12\u4e2a\u6708\u65f685\u540d(17.6%)\u60a3\u8005\u6b7b\u4ea1\u30023\u4e2a\u6708\u65f623\u540d(25.8%)\u60a3\u8005hs-CRP\u6c34\u5e73\u5347\u9ad8\uff0c6\u4e2a\u6708\u65f626\u540d(30.2%)\u60a3\u8005\uff0c12\u4e2a\u6708\u65f623\u540d(25.6%)\u60a3\u8005hs-CRP\u6c34\u5e73\u5347\u9ad8\uff1b3\u4e2a\u6708\uff0c6\u4e2a\u6708\u548c12\u4e2a\u6708\u65f6\u5206\u522b\u670945\u540d(46.4%)\uff0c40\u540d(44.9%)\u548c44\u540d(49.4%)\u60a3\u8005sPD-L1\u6c34\u5e73\u5347\u9ad8\u3002\u6839\u636ehs-CRP \u548c sPDL1s \u53d8\u5316\u7279\u5f81\u786e\u5b9a\u4e86\u4e24\u79cd\u8868\u578b\uff1a\u9ad8hs-CRP \u548c sPDL1 \u6c34\u5e73(\u9ad8\u708e\u75c7\u548c\u514d\u75ab\u529f\u80fd\u6291\u5236\u8868\u578b[326\/477 (68.3%)])\u4e0e\u6b63\u5e38 hs-CRP \u548c sPDL1 \u6c34\u5e73(\u6b63\u5e38\u8868\u578b [143\/477 (30.0%)])\u3002\u8113\u6bd2\u75c7\u8fd9\u4e9b\u8868\u578b\u5728\u4f4f\u9662\u671f\u95f4\u7684\u4e34\u5e8a\u7279\u5f81\u53ca\u4e34\u5e8a\u7ed3\u5c40\u76f8\u4f3c\u3002\u4e0e\u6b63\u5e38\u8868\u578b\u76f8\u6bd4\uff0c\u9ad8\u708e\u75c7\u548c\u514d\u75ab\u529f\u80fd\u6291\u5236\u8868\u578b\u60a3\u80051\u5e74\u75c5\u6b7b\u7387(\u6bd4\u6570\u6bd4, 8.26; 95% CI, 3.45-21.69;\u00a0P<\/em>\u2009<\u2009.001)\uff0c6\u4e2a\u6708\u5168\u56e0\u518d\u4f4f\u9662\u6216\u75c5\u6b7b\u7387(\u98ce\u9669\u6bd4 [HR], 1.53; 95% CI, 1.10-2.13;\u00a0P<\/em>\u2009=\u2009.01)\u53ca\u5fc3\u8840\u7ba1\u75be\u75c5(HR, 5.07; 95% CI, 1.18-21.84;\u00a0P<\/em>\u2009=\u2009.02)\u6216\u80bf\u7624(HR, 5.15; 95% CI, 1.25-21.18;\u00a0P<\/em>\u2009=\u2009.02)\u5bfc\u81f4\u76846\u4e2a\u6708\u518d\u4f4f\u9662\u6216\u75c5\u6b7b\u7387\u8f83\u9ad8\u3002\u4e0a\u8ff0\u76f8\u5173\u6027\u5bf9\u8113\u6bd2\u75c7\u4f4f\u9662\u671f\u95f4\u4eba\u53e3\u7edf\u8ba1\u5b66\u7279\u5f81\u3001\u6162\u6027\u75be\u75c5\u3001\u75be\u75c5\u4e25\u91cd\u7a0b\u5ea6\u3001\u5668\u5b98\u652f\u6301\u53ca\u611f\u67d3\u90e8\u4f4d\u7b49\u56e0\u7d20\u8fdb\u884c\u4e86\u6821\u6b63\uff0c\u4e14\u654f\u611f\u6027\u5206\u6790\u663e\u793a\uff0c\u7814\u7a76\u7ed3\u679c\u53ef\u9760\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>\u00a0\u7ed3\u8bba\u4e0e\u610f\u4e49<\/h3>\n\n\n\n

In this study, persistent elevation of inflammation and immunosuppression biomarkers occurred in two-thirds of patients who survived a hospitalization for sepsis and was associated with worse long-term outcomes.<\/p>\n\n\n\n

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Original Investigation Critical Care MedicineAugus […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17824"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17824"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17824\/revisions"}],"predecessor-version":[{"id":17830,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17824\/revisions\/17830"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17824"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17824"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17824"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}