背景:目的研究压力素(PSEP)变化的预测价值,降钙素原(PCT),高敏C反应蛋白(hsCRP),和白细胞介素-6(IL-6)水平对重症监护病房(ICU)脓毒症患者的死亡率。
方法:本研究纳入2020年11月至2021年12月的脓毒症患者。PSEP的水平,PCT,hsCRP,在第1天(PSEP_0,PCT_0,hsCRP_0,IL-6_0)和第3天(PSEP_3,PCT_3,hsCRP_3,IL-6_3)测量IL-6。在入组后第3、7、14、21和28天进行随访。结果是全因死亡。
结果:该研究包括119名参与者,死亡率为18.5%。在单变量Cox比例风险回归(Cox)分析中,△PSEP(=PSEP_3-PSEP_0)>211.49pg/ml(危险比(HR)2.70,95%置信区间(CI)1.17-6.22),△PCT(=PCT_3-PCT_0)>-0.13ng/ml(HR7.31,95%CI2.68-19.80),△hsCRP(=hsCRP_3-hsCRP_0)>-19.29mg/L(HR6.89,95%CI1.61-29.40),△IL-6(=IL-6_3-IL-6_0)>1.00pg/ml(HR3.13,95%CI1.35-7.24)表明死亡风险增加。所有四种不同生物标志物改变的综合一致性指数最高(一致性指数0.83,95%CI0.76-0.91),表明该小组在死亡率预测方面的最佳表现。在决策曲线分析中,与APACHEⅡ和SOFA评分相比,4种生物标志物的组合具有更大的净获益.有趣的是,IL-6主要由PBMC中的LPS刺激后的单核细胞产生。
结论:△PSEP,△PCT,△hsCRP,和△IL-6是预测ICU脓毒症患者死亡率的可靠生物标志物,和他们的组合有最好的表现。
BACKGROUND: Aim to investigate the predictive value of changes in
presepsin (PSEP), procalcitonin (PCT), high-sensitivity C-reactive protein (hsCRP), and interleukin-6 (IL-6) levels to for mortality in septic patients in intensive care unit (ICU).
METHODS: This study enrolled septic patients between November 2020 and December 2021. Levels of PSEP, PCT, hsCRP, and IL-6 were measured on 1st (PSEP_0, PCT_0, hsCRP_0, IL-6_0) and 3rd day (PSEP_3, PCT_3, hsCRP_3, IL-6_3). Follow-up was performed on days 3, 7, 14, 21, and 28 after enrollment. The outcome was all-cause death.
RESULTS: The study included 119 participants, and the mortality was 18.5%. In univariable Cox proportional-hazards regression (Cox) analysis, △PSEP (= PSEP_3- PSEP_0) > 211.49 pg/ml (hazard ratio (HR) 2.70, 95% confidence interval (CI) 1.17-6.22), △PCT (= PCT_3- PCT_0) > -0.13 ng/ml (HR 7.31, 95% CI 2.68-19.80), △hsCRP (= hsCRP_3- hsCRP_0) > -19.29 mg/L (HR 6.89, 95% CI 1.61-29.40), and △IL-6 (= IL-6_3- IL-6_0) > 1.00 pg/ml (HR 3.13, 95% CI 1.35-7.24) indicated an increased risk of mortality. The composite concordance index for alterations in all four distinct biomarkers was highest (concordance index 0.83, 95% CI 0.76-0.91), suggesting the optimal performance of this panel in mortality prediction. In decision curve analysis, compared with the APACHE Ⅱ and SOFA scores, the combination of the four biomarkers had a larger net benefit. Interestingly, IL-6 was predominantly produced by monocytes upon LPS stimulation in PBMCs.
CONCLUSIONS: △PSEP, △PCT, △hsCRP, and △IL-6 are reliable biomarkers for predicting mortality in septic patients in ICU, and their combination has the best performance.