UCI, Hospital Universitario Dr. Peset, Valencia, Spain.
Med Intensiva. 2012 Nov;36(8):556-62. doi: 10.1016/j.medin.2012.01.014. Epub 2012 Apr 10.
To determine the prognostic value of the biomarkers procalcitonin, interlukin-6 and C-reactive protein in septic patients.
A cohort of 81 septic patients.
Critical Care Unit. Dr. Peset Hospital. Valencia (Spain).
Divided according to sepsis classification (sepsis, severe sepsis and septic shock), source and two different groups (medical and postsurgical). VARIABLES ANALYZED: Quantitative (procalcitonin, interleukin-6, C-reactive protein, lactate, age, Apache II and SOFA scores upon admission and after 3 and 7 days). Qualitative (ICU mortality, multiorgan failure development and sex).
Mann-Whitney U-test for the comparison of quantitative variables, χ² test for qualitative variables. Multivariate analysis with mortality and multiorgan failure as dependent variables and the described quantitative parameters as independent variables. ROC curves of the variables found to be significant in the multivariate analysis.
Septic shock patients showed greater mortality and more frequent multiorgan failure. Comparison of survivors versus deceased patients showed significant differences in Apache II score, interleukin-6 and lactate (p<0.001) upon admission and after 3 and 7 days. Similar findings applied to the comparison of patients with and without multiorgan failure, and on the same days. Procalcitonin only showed differences on days 3 and 7 (p=0.001). In the multivariate analysis with mortality as dependent variable, interleukin-6 proved significant on day 3 (OR 2.6). With multiorgan failure as dependent variable, only the SOFA score showed significance (OR 2.3). The Apache II and interleukin-6 ROC curves corresponding to day 3 showed areas of 0.80 and 0.86, respectively.
确定降钙素原、白细胞介素-6 和 C 反应蛋白等生物标志物在脓毒症患者中的预后价值。
一项包含 81 例脓毒症患者的队列研究。
西班牙瓦伦西亚市佩塞特医院重症监护病房。
根据脓毒症分类（脓毒症、严重脓毒症和脓毒性休克）、来源和两个不同组（内科和外科手术后）进行分组。
定量变量（降钙素原、白细胞介素-6、C 反应蛋白、乳酸、年龄、入院时和第 3、7 天的 Apache II 和 SOFA 评分）；定性变量（ICU 死亡率、多器官衰竭的发生和性别）。
采用 Mann-Whitney U 检验比较定量变量，采用 χ²检验比较定性变量。对以死亡率和多器官衰竭为因变量、描述的定量参数为自变量的多变量分析。对多变量分析中发现的有意义的变量进行 ROC 曲线分析。
脓毒性休克患者的死亡率更高，多器官衰竭的发生率更高。存活患者与死亡患者比较，入院时及第 3、7 天的 Apache II 评分、白细胞介素-6 和乳酸均有显著差异（p<0.001）。同样的结果适用于有无多器官衰竭患者之间的比较，且在相同的天数。降钙素原仅在第 3、7 天有差异（p=0.001）。在以死亡率为因变量的多变量分析中，白细胞介素-6 在第 3 天有统计学意义（OR 2.6）。以多器官衰竭为因变量，只有 SOFA 评分有统计学意义（OR 2.3）。第 3 天 Apache II 和白细胞介素-6 的 ROC 曲线下面积分别为 0.80 和 0.86。
1）白细胞介素-6 是一种具有预后价值的炎症生物标志物。2）没有一种生物标志物能预测多器官衰竭。
