血清代谢-能量双轴标志对脓毒性休克患者病情程度及临床结局的预测价值OA

Objective To investigate the predictive value of serum metabolism-energy dual-axis biomarkers for the severity and clinical outcomes of patients with septic shock(SS).Methods A total of 108 patients with SS admitted to the Department of Critical Care Medicine,Yibin First People's Hospital,Sichuan Province from January 2022 to January 2025 were selected as the SS group.In addition,108 patients with simple sepsis admitted during the same period were selected as the sepsis group,and 108 healthy subjects were selected as the healthy control group at a 1:1 ratio.Based on disease severity,SS patients were divided into a mild SS subgroup(29 cases),a moderate SS subgroup(36 cases),and a severe SS subgroup(43 cases).According to clinical outcomes at 28 days after admission,SS patients were divided into a death subgroup and a survival subgroup.Serum levels of pyruvate kinase M2(PKM2)and sirtuin 3(SIRT3)were measured by ELISA.The correla-tion between serum PKM2 and SIRT3 levels and disease severity was analyzed.Factors influencing clinical outcomes and the predictive efficacy of serum PKM2 and SIRT3 levels for adverse clinical outcomes in SS patients were analyzed.Results Se-rum PKM2 levels were progressively higher in the healthy control,sepsis,and SS groups,while SIRT3 levels were progres-sively lower(F/P=457.295/<0.001,191.296/<0.001).Serum PKM2 levels were progressively higher across the mild,moderate,and severe SS subgroups,while SIRT3 levels were progressively lower(F/P=38.370/<0.001,25.819/<0.001).Dis-ease severity in SS patients was positively correlated with serum PKM2 levels and negatively correlated with SIRT3 levels(rs/P=0.606/<0.001,-0.645/<0.001).The 28-day mortality rate among the 108 SS patients was 37.96%(41/108).Compared with the survival subgroup,the death subgroup had significantly higher serum PKM2 levels and significantly lower SIRT3 lev-els(t/P=7.930/<0.001,-7.100/<0.001).Disease severity,mechanical ventilation duration≥3 days,elevated sequential organ failure assessment(SOFA)score,and elevated PKM2 were independent risk factors for adverse clinical outcomes in SS pa-tients,while elevated SIRT3 was an independent protective factor[OR(95%CI)=4.773(2.075-10.979),4.877(1.056-22.511),2.122(1.367-3.295),1.119(1.052-1.189),0.614(0.476-0.791)].The AUCs of serum PKM2,SIRT3,and their combination for predicting adverse clinical outcomes were 0.812,0.827,and 0.924,respectively.The combined prediction showed significantly greater AUC than either marker alone(Z/P=3.110/0.002,2.744/0.006).Conclusion Elevated serum PKM2 and decreased SIRT3 levels are associated with disease severity and are independent predictors of mortality.The combi-nation of these two markers provides high predictive value for clinical outcomes in SS patients.