Hynninen Marja, Pettilä Ville, Takkunen Olli, Orko Riitta, Jansson Sten-Erik, Kuusela Pentti, Renkonen Risto, Valtonen Matti
Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, PO Box 340, 00029 HUS, Helsinki, Finland.
Shock. 2003 Jul;20(1):1-4. doi: 10.1097/01.shk.0000068322.08268.b4.
It has been suggested that excessive activation of the anti-inflammatory pathways in sepsis may lead to poor outcome of patients with sepsis. The aim of this study was to test the value of histocompatibility leukocyte antigen (HLA)-DR-expression on blood monocytes and plasma levels of interleukin (IL)-4 and -10 in prediction of hospital mortality in patients with sepsis. Sixty-one critically ill patients with sepsis were prospectively enrolled to this study in two university hospital intensive care units. Survivors (n = 41) and nonsurvivors (n = 20) differed significantly in HLA-DR expression at admission: survivors' median 84% (interquartile range 64%-98%) versus nonsurvivors' median 62% (interquartile range 47%-83%, P = 0.025 by Mann-Whitney test). Similarly, the analysis revealed statistically significant differences between survivors and nonsurvivors in admission plasma IL-10 levels and in admission Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, but not in IL-4 levels. The areas under receiver operating curves (AUC) showed that both monocyte HLA-DR expression and plasma IL-4 level showed poor discriminative power in prediction of hospital mortality (AUC < 0.70). Only IL-10 levels on days 1 and 2 showed reasonable predictive power (AUCs 0.706 and 0.725, respectively). The highest AUC values were those of APACHE-II (0.786) and admission SOFA score (0.763). In conclusion, APACHE II and SOFA scores on admission showed better discriminatory power than HLA-DR expression and IL-10 and IL-4 levels in prediction of hospital mortality in critically ill patients with sepsis.
有人提出，脓毒症中抗炎途径的过度激活可能导致脓毒症患者预后不良。本研究的目的是检测血液单核细胞上组织相容性白细胞抗原（HLA）-DR的表达以及白细胞介素（IL）-4和-10的血浆水平在预测脓毒症患者医院死亡率方面的价值。在两家大学医院的重症监护病房中，对61例重症脓毒症患者进行了前瞻性研究。幸存者（n = 41）和非幸存者（n = 20）在入院时HLA-DR表达存在显著差异：幸存者的中位数为84%（四分位间距64%-98%），而非幸存者的中位数为62%（四分位间距47%-83%，曼-惠特尼检验P = 0.025）。同样，分析显示幸存者和非幸存者在入院时血浆IL-10水平、入院时序贯器官衰竭评估（SOFA）和急性生理与慢性健康状况评估（APACHE）II评分方面存在统计学显著差异，但在IL-4水平上无差异。受试者工作特征曲线（AUC）下面积显示，单核细胞HLA-DR表达和血浆IL-4水平在预测医院死亡率方面的鉴别能力较差（AUC < 0.70）。仅第1天和第2天的IL-10水平显示出合理的预测能力（AUC分别为0.706和0.725）。AUC最高的值是APACHE-II（0.786）和入院时SOFA评分（0.763）。总之，在预测重症脓毒症患者的医院死亡率方面，入院时的APACHE II和SOFA评分比HLA-DR表达以及IL-10和IL-4水平具有更好的鉴别能力。
