Giannoudis Peter V, Harwood Paul John, Loughenbury Peter, Van Griensven Martijn, Krettek Christian, Pape Hans-Christoph
Academic Department of Trauma Surgery, Leeds University, Leeds, United Kingdom.
J Trauma. 2008 Sep;65(3):646-52. doi: 10.1097/TA.0b013e3181820d48.
Recently, increasing emphasis is being placed upon assessment of the inflammatory status of the patient. Serum inflammatory cytokines, particularly IL-6, have been used as an adjunct to this assessment. Another method uses a combination of simple laboratory and clinical data to provide an assessment of the patient's current level of systemic inflammation, the SIRS. The aim of this study was to investigate, in a group of adult trauma patients, the relationship between the interleukin-6 (IL-6) concentration, the systemic inflammatory response score (SIRS) and outcome.
In patients with femoral shaft fracture, serum IL-6 levels and clinical parameters were recorded prospectively on admission and on days 1, 3, 5, and 7. Clinical course, the SIRS score and complications were documented. Nonparametric tests were used to assess relationships between variables and receiver operator characteristic (ROC) curves were used to examine their predictive values. Significance was assumed at the p < 0.05 level.
Forty-eight patients were included in the final analysis, with a median new injury severity score (NISS) of 31.5 (range, 9-75). The presence of a "SIRS state" detected early (day 1 and 3) positively correlated with the IL-6 measurement from the same period (p < 0.001). ROC curve analysis revealed elevated IL-6 to be significantly diagnostic of a SIRS state (p < 0.001) at all times. Early (days 0 and 1), an IL-6 value above 200 pg/dL diagnosed a SIRS state with an 83% sensitivity and a 75% specificity (area under ROC curve 0.76, p < 0.0001). Both a SIRS state and an IL-6 > 300 pg/mL was associated with a significantly increased risk of complication (pneumonia, MOF, death). Both systems were found to be significantly diagnostic of these complications using ROC curve analysis.
The IL-6 concentration and SIRS score are useful adjuncts to clinical evaluation of the injured patient. In the early phase, they are closely correlated with the NISS and each other. A cutoff value of 200 pg/dL was shown to be significantly diagnostic of a SIRS state. Significant correlations between adverse events and both the IL-6 level and SIRS state are demonstrated.
最近，对患者炎症状态评估的重视程度日益增加。血清炎症细胞因子，尤其是白细胞介素-6（IL-6），已被用作该评估的辅助手段。另一种方法是结合简单的实验室和临床数据来评估患者当前的全身炎症水平，即全身炎症反应综合征（SIRS）。本研究的目的是在一组成年创伤患者中，调查白细胞介素-6（IL-6）浓度、全身炎症反应评分（SIRS）与预后之间的关系。
对于股骨干骨折患者，在入院时以及第1、3、5和7天前瞻性记录血清IL-6水平和临床参数。记录临床病程、SIRS评分和并发症。使用非参数检验评估变量之间的关系，并使用受试者操作特征（ROC）曲线检查其预测价值。以p < 0.05水平为有统计学意义。
48例患者纳入最终分析，新损伤严重程度评分（NISS）中位数为31.5（范围9 - 75）。早期（第1天和第3天）检测到的“全身炎症反应综合征状态”与同期的IL-6测量值呈正相关（p < 0.001）。ROC曲线分析显示，IL-6升高在所有时间均对全身炎症反应综合征状态具有显著诊断意义（p < 0.001）。早期（第0天和第1天），IL-6值高于200 pg/dL诊断全身炎症反应综合征状态的灵敏度为83%，特异度为75%（ROC曲线下面积0.76，p < 0.0001）。全身炎症反应综合征状态和IL-6 > 300 pg/mL均与并发症（肺炎、多器官功能衰竭、死亡）风险显著增加相关。使用ROC曲线分析发现这两种指标对这些并发症均具有显著诊断意义。
IL-6浓度和SIRS评分是对受伤患者进行临床评估的有用辅助指标。在早期阶段，它们与NISS密切相关且相互关联。200 pg/dL的临界值对全身炎症反应综合征状态具有显著诊断意义。不良事件与IL-6水平和全身炎症反应综合征状态之间均存在显著相关性。
