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Abstract: PO0050

Elevated Serum Tenascin C Predicts All-Cause Mortality in Critically Ill Patients with Multiple Organ Dysfunction

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Xie, Qionghong, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Yunyu, Xu, Huashan Hospital Fudan University, Shanghai, Shanghai, China
  • Hao, Chuan-Ming, Huashan Hospital Fudan University, Shanghai, Shanghai, China
Background

Tenascin-C (TNC) is a matricellular protein that is rarely expressed in most of adult tissues, but re-induced following injury. This study aimed to evaluate serum TNC in predicting all-cause mortality in critical ill patients with multiple organ dysfunction.

Methods

Adult critical ill patients who met the criteria of at least two organs dysfunction and acute organ injury with an increase of SOFA ≥ 2 points within 7 days were prospectively enrolled in one derivation cohort (Medical ward) and one external validation cohort (Emergency ward). Serum TNC was measured within the first 24 hours after enrollment and the association between serum TNC and 28-day all-cause mortality was analyzed.

Results

A total of 115 patients with median age 56 (38, 66) years and male of 65.2% in derivation cohort and 110 patients with median (quartile) age of 64 (53, 73) and male of 67% in validation cohort were enrolled. Serum TNC was 210.2 (96.8, 469.6) ng/ml in derivation cohort and 229.4 (141.6, 472.5) ng/ml in validation cohort, both significantly higher than that in healthy controls (median 80.9 ng/ml, n=46, p<0.01 for both). The TNC levels were positively associated with the critical illness scores such as SOFA, APACHE II and SPAS II, as well as 28-day mortality (p<0.01 for all). Compared to the patients with TNC<300ng/ml, patients with TNC≥300ng/ml had a remarkably higher 28-day mortality (38.6% vs. 14.1%, p=0.003 in derivation cohort; 57.8% vs. 13.8%, p<0.001 in validation cohort). In multivariate analysis, serum TNC was independently associated with the mortality after adjustment for age, gender and SOFA in both cohorts. The areas under the Receiver Operating Curve of TNC for 28-day mortality was 0.797 in derivation cohort and 0.803 in validation cohort, not inferior to SOFA (0.844 and 0.808), APACHE II (0.86 and 0.762) and SPAS II (0.872 and 0.779).

Conclusion

Serum TNC was significantly increased in critical ill patients with multiple organ dysfunction and was positively associated with the severity of illness and all-cause mortality. It was a useful prognostic tool for predicting all-cause mortality in critical ill patients.