Emergency Department, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
PLoS One. 2011;6(12):e28870. doi: 10.1371/journal.pone.0028870. Epub 2011 Dec 29.
Morbidity, mortality and social cost of sepsis are high. Previous studies have suggested that individual cytokines levels could be used as sepsis markers. Therefore, we assessed whether the multiplex technology could identify useful cytokine profiles in Emergency Department (ED) patients.
ED patients were included in a single tertiary-care center prospective study. Eligible patients were >18 years and met at least one of the following criteria: fever, suspected systemic infection, ≥ 2 systemic inflammatory response syndrome (SIRS) criteria, hypotension or shock. Multiplex cytokine measurements were performed on serum samples collected at inclusion. Associations between cytokine levels and sepsis were assessed using univariate and multivariate logistic regressions, principal component analysis (PCA) and agglomerative hierarchical clustering (AHC).
Among the 126 patients (71 men, 55 women; median age: 54 years [19-96 years]) included, 102 had SIRS (81%), 55 (44%) had severe sepsis and 10 (8%) had septic shock. Univariate analysis revealed weak associations between cytokine levels and sepsis. Multivariate analysis revealed independent association between sIL-2R (p = 0.01) and severe sepsis, as well as between sIL-2R (p = 0.04), IL-1β (p = 0.046), IL-8 (p = 0.02) and septic shock. However, neither PCA nor AHC distinguished profiles characteristic of sepsis.
Previous non-multiparametric studies might have reached inappropriate conclusions. Indeed, well-defined clinical conditions do not translate into particular cytokine profiles. Additional and larger trials are now required to validate the limited interest of expensive multiplex cytokine profiling for staging septic patients.
脓毒症的发病率、死亡率和社会成本都很高。先前的研究表明，单个细胞因子水平可以用作脓毒症的标志物。因此，我们评估了多重分析技术是否可以在急诊部（ED）患者中识别有用的细胞因子谱。
ED 患者被纳入一项单中心前瞻性研究。符合条件的患者年龄>18 岁，至少符合以下标准之一：发热、疑似全身感染、≥2 个全身炎症反应综合征（SIRS）标准、低血压或休克。在纳入时采集血清样本进行多重细胞因子测量。使用单变量和多变量逻辑回归、主成分分析（PCA）和凝聚层次聚类（AHC）评估细胞因子水平与脓毒症之间的关联。
在纳入的 126 例患者（71 名男性，55 名女性；中位年龄：54 岁[19-96 岁]）中，102 例有 SIRS（81%），55 例（44%）有严重脓毒症，10 例（8%）有感染性休克。单变量分析显示细胞因子水平与脓毒症之间存在弱关联。多变量分析显示 sIL-2R（p=0.01）与严重脓毒症以及 sIL-2R（p=0.04）、IL-1β（p=0.046）、IL-8（p=0.02）与感染性休克之间存在独立关联。然而，PCA 和 AHC 均未区分出具有脓毒症特征的特征性图谱。
先前的非多参数研究可能得出了不恰当的结论。事实上，明确界定的临床条件并不能转化为特定的细胞因子图谱。现在需要进行更多和更大的试验来验证昂贵的多重细胞因子分析对分期脓毒症患者的有限意义。
