Department of Pneumology, Carl-Thiem-Klinikum Cottbus, Thiemstrasse 111, 03048 Cottbus, Germany.
BMC Pulm Med. 2012 Feb 20;12:6. doi: 10.1186/1471-2466-12-6.
The aim of our study was to investigate the predictive value of the biomarkers interleukin 6 (IL-6), interleukin 10 (IL-10) and lipopolysaccharide-binding protein (LBP) compared with clinical CRB and CRB-65 severity scores in patients with community-acquired pneumonia (CAP).
Samples and data were obtained from patients enrolled into the German CAPNETZ study group. Samples (blood, sputum and urine) were collected within 24 h of first presentation and inclusion in the CAPNETZ study, and CRB and CRB-65 scores were determined for all patients at the time of enrollment. The combined end point representative of a severe course of CAP was defined as mechanical ventilation, intensive care unit treatment and/or death within 30 days. Overall, a total of 1,000 patients were enrolled in the study. A severe course of CAP was observed in 105 (10.5%) patients.
The highest IL-6, IL-10 and LBP concentrations were found in patients with CRB-65 scores of 3-4 or CRB scores of 2-3. IL-6 and LBP levels on enrollment in the study were significantly higher for patients with a severe course of CAP than for those who did not have severe CAP. In receiver operating characteristic analyses, the area under the curve values for of IL-6 (0.689), IL-10 (0.665) and LPB (0.624) in a severe course of CAP were lower than that of CRB-65 (0.764) and similar to that of CRB (0.69). The accuracy of both CRB and CRB-65 was increased significantly by including IL-6 measurements. In addition, higher cytokine concentrations were found in patients with typical bacterial infections compared with patients with atypical or viral infections and those with infection of unknown etiology. LBP showed the highest discriminatory power with respect to the etiology of infection.
IL-6, IL-10 and LBP concentrations were increased in patients with a CRB-65 score of 3-4 and a severe course of CAP. The concentrations of IL-6 and IL-10 reflected the severity of disease in patients with CAP. The predictive power of IL-6, IL-10 and LBP for a severe course of pneumonia was lower than that of CRB-65. Typical bacterial pathogens induced the highest LBP, IL-6 and IL-10 concentrations.
本研究旨在探讨生物标志物白细胞介素 6（IL-6）、白细胞介素 10（IL-10）和脂多糖结合蛋白（LBP）与临床 CRB 和 CRB-65 严重程度评分相比，在社区获得性肺炎（CAP）患者中的预测价值。
本研究的样本和数据来自德国 CAPNETZ 研究组纳入的患者。所有患者在首次就诊和纳入 CAPNETZ 研究的 24 小时内采集样本（血液、痰液和尿液），并在入组时确定所有患者的 CRB 和 CRB-65 评分。代表 CAP 严重病程的联合终点定义为 30 天内机械通气、重症监护治疗和/或死亡。共有 1000 例患者入组本研究。105 例（10.5%）患者发生 CAP 严重病程。
CRB-65 评分 3-4 分或 CRB 评分 2-3 分的患者 IL-6、IL-10 和 LBP 浓度最高。与 CAP 病情不严重的患者相比，CAP 病情严重的患者在入组时 IL-6 和 LBP 水平显著升高。在接受者操作特征分析中，IL-6（0.689）、IL-10（0.665）和 LPB（0.624）在 CAP 严重病程中的曲线下面积值低于 CRB-65（0.764），与 CRB（0.69）相似。通过纳入 IL-6 测量，CRB 和 CRB-65 的准确性均显著提高。此外，与非典型或病毒性感染以及病因不明的感染患者相比，典型细菌感染患者的细胞因子浓度更高。LBP 对感染病因具有最高的鉴别能力。
CRB-65 评分 3-4 分和 CAP 严重病程患者的 IL-6、IL-10 和 LBP 浓度升高。IL-6 和 IL-10 浓度反映了 CAP 患者的疾病严重程度。IL-6、IL-10 和 LBP 对肺炎严重病程的预测能力低于 CRB-65。典型细菌病原体诱导的 LBP、IL-6 和 IL-10 浓度最高。
