title: Diagnostic and prognostic utility of tissue factor for severe sepsis and sepsis-induced acute lung injury.
abstract: BACKGROUND
  Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) play a central role in the endothelial permeability regulation and dysfunction, which is associated with the development of sepsis and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The aim of this study is to assess the diagnostic and prognostic values of TF and TFPI in patients with sepsis and sepsis-induced ARDS.
  
  
  METHODS
  A total of 62 patients with sepsis, 167 patients with severe sepsis and 32 healthy volunteers were enrolled in this prospective observational study. TF and TFPI levels were measured by enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  Patients with sepsis-induced ARDS showed significantly higher median levels of TF compared with patients without ARDS (1425.5 (1019.9 to 2595.2) pg/ml vs 916.2 (724.1 to 1618.2) pg/ml, P < 0.001), and compared with sepsis patients (943.5 (786.4 to 992.4) pg/ml, P < 0.001) on the day of admission. However, there was no significant difference between sepsis patients and healthy subjects, or between septic shock and non-septic shock patients (P > 0.05). The AUC of TF for the diagnosis of sepsis-induced ARDS was 0.749 (95% confidence interval (CI) 0.675-0.822). Plasma TF levels in the non-survivors of severe sepsis were significantly higher than those of survivors (1618.6 (1017.1 to 2900.8) pg/ml vs. 979.9 (757.2 to 1645.5) pg/ml, P < 0.001), and multivariate logistic regression showed the plasma value of TF was the independent predictor for 30-day mortality in patients with severe sepsis (P = 0.0022, odds ratio (OR) = 1.41, 95% CI 1.24-1.69). The AUC of TF for predicting 30-day mortality in severe sepsis patients was 0.718 (95% CI 0.641-0.794). However, there was no significant difference in the plasma TFPI values among the healthy control, sepsis and severe sepsis groups (P > 0.05).
  
  
  CONCLUSIONS
  Our data showed that tissue factor is a valuable diagnostic biomarker for the diagnosis of sepsis-induced ARDS. Moreover, tissue factor is a strong prognostic marker for short-term mortality in severe sepsis and sepsis-induced ARDS patients.
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. xue.mingming@zs-hospital.sh.cn.
authors.forename: Mingming
authors.initials: M
authors.lastname: Xue
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. sun.zhan@zs-hospital.sh.cn.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. shaomian11@hotmail.com.
authors.forename: Mian
authors.initials: M
authors.lastname: Shao
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. yin.jun@zs-hospital.sh.cn.
authors.forename: Jun
authors.initials: J
authors.lastname: Yin
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. deng.zhi@zs-hospital.sh.cn.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Deng
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. zhang.jin@zs-hospital.sh.cn.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. xing.lingyu@zs-hospital.sh.cn.
authors.forename: Lingyu
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. yang.xiaoliang@zs-hospital.sh.cn.
authors.forename: Xiaoliang
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. chen.bin@zs-hospital.sh.cn.
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. dong.zhimin@zs-hospital.sh.cn.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Dong
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. han.yi@zs-hospital.sh.cn.
authors.forename: Yi
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. sun.si@zs-hospital.sh.cn.
authors.forename: Si
authors.initials: S
authors.lastname: Sun
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. wang.yuxin@zs-hospital.sh.cn.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. yao.chenling@zs-hospital.sh.cn.
authors.forename: Chenling
authors.initials: C
authors.lastname: Yao
authors.affiliation: Department of Genetics, Chinese National Human Genome Center, 250 BiBo Road, Shanghai, 201203, PR China. chux@chgc.sh.cn.
authors.forename: Xun
authors.initials: X
authors.lastname: Chu
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. tong.chaoyang@zs-hospital.sh.cn.
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Tong
authors.affiliation: Department of Emergency Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, PR China. zhenjusong@yahoo.com.
authors.forename: Zhenju
authors.initials: Z
authors.lastname: Song
mesh_terms: D055371:Acute Lung Injury / Q000097:blood* / Q000209:etiology*; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000097:blood; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D016019:Survival Analysis; D013925:Thromboplastin / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D013925:Thromboplastin