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Abstract：
BACKGROUND: The recently used pan-immune-inflammation value (PIV) has not been adequately studied as a predictive marker for mortality in immunosuppressed patients. The aim of this study was to evaluate the usefulness of baseline PIV level as a predictor of 30-day mortality in solid organ transplant (SOT) recipients with gram negative bloodstream infections (GN-BSI).
METHODS: This retrospective, cross-sectional study was conducted between January 1, 2019, and December 31, 2022, in 1104 SOT recipients. During the study period, 118 GN-BSI were recorded in 113 patients. Clinical, epidemiological, and laboratory data were collected, and mortality rates (30-day and all-cause) were recorded.
RESULTS: The 113 recipients had a median age of 50 years [interquartile range (IQR) 37.5-61.5 years] with a male predominance (n = 72, 63.7%). The three most common microorganisms were as follows: 46 isolates (38.9%) of Escherichia coli, 41 (34.7%) of Klebsiella pneumoniae, and 12 (10.2%) of Acinetobacter baumannii. In 44.9% and 35.6% of the isolates, production of extended-spectrum beta-lactamases and carbapenem resistance were detected, respectively. The incidence of carbapenem-resistant GN-BSI was higher in liver recipients than in renal recipients (n = 27, 69.2% vs n = 13, 17.6%, p < 0.001). All-cause and 30-day mortality rates after GN-BSI were 26.5% (n = 30), and 16.8% (n = 19), respectively. In the group with GN-BSI-related 30-day mortality, the median PIV level was significantly lower (327.3, IQR 64.8-795.4 vs. 1049.6, IQR 338.6-2177.1; p = 0.002). The binary logistic regression analysis identified low PIV level [hazard ratio (HR) = 0.93, 95% confidence interval (CI) 0.86-0.99; p = 0.04], and increased age (HR = 1.05, 95% CI 1.01-1.09; p = 0.002) as factors associated with 30-day mortality. The receiver operating characteristic analysis revealed that PIV could determine the GN-BSI-related 30-day mortality with area under curve (AUC): 0.723, 95% CI 0.597-0.848, p = 0.0005.
CONCLUSIONS: PIV is a simple and inexpensive biomarker that can be used to estimate mortality in immunosuppressed patients, but the results need to be interpreted carefully.
METHODS: This retrospective, cross-sectional study was conducted between January 1, 2019, and December 31, 2022, in 1104 SOT recipients. During the study period, 118 GN-BSI were recorded in 113 patients. Clinical, epidemiological, and laboratory data were collected, and mortality rates (30-day and all-cause) were recorded.
RESULTS: The 113 recipients had a median age of 50 years [interquartile range (IQR) 37.5-61.5 years] with a male predominance (n = 72, 63.7%). The three most common microorganisms were as follows: 46 isolates (38.9%) of Escherichia coli, 41 (34.7%) of Klebsiella pneumoniae, and 12 (10.2%) of Acinetobacter baumannii. In 44.9% and 35.6% of the isolates, production of extended-spectrum beta-lactamases and carbapenem resistance were detected, respectively. The incidence of carbapenem-resistant GN-BSI was higher in liver recipients than in renal recipients (n = 27, 69.2% vs n = 13, 17.6%, p < 0.001). All-cause and 30-day mortality rates after GN-BSI were 26.5% (n = 30), and 16.8% (n = 19), respectively. In the group with GN-BSI-related 30-day mortality, the median PIV level was significantly lower (327.3, IQR 64.8-795.4 vs. 1049.6, IQR 338.6-2177.1; p = 0.002). The binary logistic regression analysis identified low PIV level [hazard ratio (HR) = 0.93, 95% confidence interval (CI) 0.86-0.99; p = 0.04], and increased age (HR = 1.05, 95% CI 1.01-1.09; p = 0.002) as factors associated with 30-day mortality. The receiver operating characteristic analysis revealed that PIV could determine the GN-BSI-related 30-day mortality with area under curve (AUC): 0.723, 95% CI 0.597-0.848, p = 0.0005.
CONCLUSIONS: PIV is a simple and inexpensive biomarker that can be used to estimate mortality in immunosuppressed patients, but the results need to be interpreted carefully.
摘要：
背景：最近使用的泛免疫炎症值（PIV）尚未被充分研究为免疫抑制患者死亡率的预测指标。这项研究的目的是评估基线PIV水平作为革兰氏阴性血流感染（GN-BSI）的实体器官移植（SOT）接受者30天死亡率的预测因子的有用性。
方法：本回顾性研究，横断面研究于2019年1月1日至2022年12月31日期间在1104名SOT接受者中进行.在学习期间,113例患者共记录118GN-BSI。临床,流行病学,收集了实验室数据，并记录死亡率(30日及全因).
结果：113名接受者的中位年龄为50岁[四分位距（IQR）37.5-61.5岁]，男性占优势（n=72，63.7％）。最常见的三种微生物如下:46株(38.9%)大肠杆菌,41例（34.7%）肺炎克雷伯菌，鲍曼不动杆菌12例(10.2%)。在44.9%和35.6%的分离物中，检测到产超广谱β-内酰胺酶和碳青霉烯耐药性，分别。碳青霉烯类耐药GN-BSI在肝脏受者中的发生率高于肾脏受者（n=27，69.2％vsn=13，17.6％，p<0.001)。GN-BSI后的全因死亡率和30天死亡率为26.5％（n=30），和16.8%(n=19)，分别。在GN-BSI相关的30天死亡率组中，PIV中位数水平显着降低（327.3，IQR64.8-795.4与1049.6，IQR338.6-2177.1；p=0.002）。二元逻辑回归分析确定了低PIV水平[风险比（HR）=0.93，95％置信区间（CI）0.86-0.99；p=0.04]，年龄增加（HR=1.05，95％CI1.01-1.09；p=0.002）是与30天死亡率相关的因素。受试者工作特征分析显示，PIV可以确定GN-BSI相关的30天死亡率，曲线下面积（AUC）：0.723，95％CI0.597-0.848，p=0.0005。
结论：PIV是一种简单而廉价的生物标志物，可用于估计免疫抑制患者的死亡率。但结果需要仔细解释。
方法：本回顾性研究，横断面研究于2019年1月1日至2022年12月31日期间在1104名SOT接受者中进行.在学习期间,113例患者共记录118GN-BSI。临床,流行病学,收集了实验室数据，并记录死亡率(30日及全因).
结果：113名接受者的中位年龄为50岁[四分位距（IQR）37.5-61.5岁]，男性占优势（n=72，63.7％）。最常见的三种微生物如下:46株(38.9%)大肠杆菌,41例（34.7%）肺炎克雷伯菌，鲍曼不动杆菌12例(10.2%)。在44.9%和35.6%的分离物中，检测到产超广谱β-内酰胺酶和碳青霉烯耐药性，分别。碳青霉烯类耐药GN-BSI在肝脏受者中的发生率高于肾脏受者（n=27，69.2％vsn=13，17.6％，p<0.001)。GN-BSI后的全因死亡率和30天死亡率为26.5％（n=30），和16.8%(n=19)，分别。在GN-BSI相关的30天死亡率组中，PIV中位数水平显着降低（327.3，IQR64.8-795.4与1049.6，IQR338.6-2177.1；p=0.002）。二元逻辑回归分析确定了低PIV水平[风险比（HR）=0.93，95％置信区间（CI）0.86-0.99；p=0.04]，年龄增加（HR=1.05，95％CI1.01-1.09；p=0.002）是与30天死亡率相关的因素。受试者工作特征分析显示，PIV可以确定GN-BSI相关的30天死亡率，曲线下面积（AUC）：0.723，95％CI0.597-0.848，p=0.0005。
结论：PIV是一种简单而廉价的生物标志物，可用于估计免疫抑制患者的死亡率。但结果需要仔细解释。
