目的：敗血症是孕产妇死亡的主要原因，而在黄金时间内诊断敗血症对于提高生存率至关重要。妊娠期急性肾盂肾炎是产科和医学并发症的危险因素，也是敗血症的主要原因，因为菌血症并发于妊娠期的肾盂肾炎病例中约占15-20％。目前，血液培养是诊断菌血症的依据，而快速测试则可能使得及时管理和改善结果成为可能。可溶性肿瘤原抑制因子2（sST2）曾被提议为非孕产妇和儿童敗血症的生物标志物。本研究旨在确定孕妇妊娠期患有肾盂肾炎的患者的sST2体内浓度是否有助于识别菌血症风险。研究设计：本横断面研究包括正常妊娠的女性（n = 131）和患有急性肾盂肾炎的孕妇（n = 36）。急性肾盂肾炎的诊断基于临床表现和尿培养阳性的组合。根据血液培养结果进一步分为有和没有菌血症的患者。sST2的体内浓度通过敏感的免疫测定方法来确定。采用非参数统计进行分析。结果：孕妇体内sST2浓度随着正常妊娠的妊娠周数增加而增加。患有急性肾盂肾炎的孕妇的中位数（四分位距）血浆sST2浓度高于正常妊娠的孕妇[85(47-239) ng/mL vs. 31(14-52) ng/mL，p < .001]。在肾盂肾炎患者中，血培养阳性的患者的sST2体内浓度中位数高于血培养阴性的患者[258(IQR：75-305) ng/mL vs. 83(IQR：46-153) ng/mL；p = 0.03]。sST2体内浓度≥215 ng/mL的升高对于识别血培养阳性的患者有73％的敏感性和95％的特异性（接收器操作特征曲线下面积为0.74，p =0.003），同时具有13.8的阳性似然比和0.3的阴性似然比。结论：sST2是识别妊娠期患有肾盂肾炎的孕妇中的菌血症的候选生物标志物。迅速识别这些患者可以优化患者护理。

Objective: Sepsis is a leading cause of maternal death, and its diagnosis during the golden hour is critical to improve survival. Acute pyelonephritis in pregnancy is a risk factor for obstetrical and medical complications, and it is a major cause of sepsis, as bacteremia complicates 15-20% of pyelonephritis episodes in pregnancy. The diagnosis of bacteremia currently relies on blood cultures, whereas a rapid test could allow timely management and improved outcomes. Soluble suppression of tumorigenicity 2 (sST2) was previously proposed as a biomarker for sepsis in non-pregnant adults and children. This study was designed to determine whether maternal plasma concentrations of sST2 in pregnant patients with pyelonephritis can help to identify those at risk for bacteremia.Study design: This cross-sectional study included women with normal pregnancy (n = 131) and pregnant women with acute pyelonephritis (n = 36). Acute pyelonephritis was diagnosed based on a combination of clinical findings and a positive urine culture. Patients were further classified according to the results of blood cultures into those with and without bacteremia. Plasma concentrations of sST2 were determined by a sensitive immunoassay. Non-parametric statistics were used for analysis.Results: The maternal plasma sST2 concentration increased with gestational age in normal pregnancies. Pregnant patients with acute pyelonephritis had a higher median (interquartile range) plasma sST2 concentration than those with a normal pregnancy [85 (47-239) ng/mL vs. 31 (14-52) ng/mL, p < .001]. Among patients with pyelonephritis, those with a positive blood culture had a median plasma concentration of sST2 higher than that of patients with a negative blood culture [258 (IQR: 75-305) ng/mL vs. 83 (IQR: 46-153) ng/mL; p = .03]. An elevated plasma concentration of sST2 ≥ 215 ng/mL had a sensitivity of 73% and a specificity of 95% (area under the receiver operating characteristic curve, 0.74; p = .003) with a positive likelihood ratio of 13.8 and a negative likelihood ratio of 0.3 for the identification of patients who had a positive blood culture.Conclusion: sST2 is a candidate biomarker to identify bacteremia in pregnant women with pyelonephritis. Rapid identification of these patients may optimize patient care.