血清sCD40L和sTREM-1联合危重症评分对严重脓毒症住院患者预后的预测价值OA

Objective To evaluate the clinical value of soluble CD40 ligand(sCD40L)combined with soluble triggering receptor expressed on myeloid cells-1(sTREM-1),together with the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score and the sequential organ failure assessment(SOFA)score,in predicting in-hospital mortality of patients with severe sepsis.Methods A total of 203 patients with severe sepsis admitted to the department of intensive care unit(ICU)of the Affiliated Hospital of Jining Medical University from August 2024 to July 2025 were enrolled.Patients were divided into survival and death groups according to their in-hospital outcomes.Demographic data vital signs on ICU admission,disease severity scores,laboratory indicators within 24 hours of admission,ICU length of stay,hospital outcomes,sCD40L and sTREM-1 levels within 2 hours after sepsis diagnosis were systematically collected.Differences in these parameters were detected between the two groups.Multivariable Logistic regression analysis was used to analyze the effects of sCD40L,sTREM-1 combined with APACHEⅡand SOFA scores on in-hospital mortality.Receiver operator characteristic curve(ROC curve)were used to evaluate the predictive performance of individual indicators and combined models for the prognosis of patients with severe sepsis.Results Of the 203 patients,178 survived and 25 died,yielding an in-hospital mortality of 12.32%.sCD40L,sTREM-1,APACHEⅡscore,and SOFA score were significantly higher in the death group than in the survival group[sCD40L(μg/L):4.8(2.5,6.7)vs.1.1(0.4,4.1),sTREM-1(ng/L):1 781.7(1 338.7,1 942.7)vs.944.5(495.4,1 453.2),APACHEⅡ score:26.7±7.3 vs.21.6±7.6,SOFA score:11(8,14)vs.7(5,10);all P<0.05].Multivariable Logistic regression showed that sCD40L,sTREM-1,APACHE Ⅱ,and SOFA scores were independent risk factors for in-hospital mortality(all P<0.05),and the results remained robust after adjustment for confounders.ROC curve analysis showed that the combined sCD40L+sTREM-1+SOFA model yielded an area under the curve(AUC)of 0.838 2[95%confidence interval(95%CI):0.775 1-0.901 3],P=0.000 0,demonstrating superior predictive performance compared with sCD40L+sTREM-1+APACHEⅡ,sCD40L+sTREM-1,and each individual indicator sCD40L,sTREM-1,APACHE Ⅱ score,and SOFA score[AUC(95%CI):0.802 5(0.718 2-0.886 7),0.784 3(0.700 4-0.868 2),0.758 2(0.666 9-0.849 5),0.755 7(0.662 7-0.848 7),0.701 9(0.599 8-0.803 9),and 0.745 1(0.660 6-0.829 5),respectively].Conclusion sCD40L combined with sTREM-1 and SOFA score has good predictive value for in-hospital mortality in patients with sepsis,outperforming any single indicator.