Department of Respiratory Medicine, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan Province, China.
PLoS One. 2012;7(7):e38400. doi: 10.1371/journal.pone.0038400. Epub 2012 Jul 20.
We investigated serum soluble CD163 (sCD163) levels for use in the diagnosis, severity assessment, and prognosis of sepsis in the critical ill patients and compared sCD163 with other infection-related variables.
During july 2010 and April 2011, serum was obtained from 102 sepsis patients (days 1, 3, 5, 7, and 10 after admission to an ICU) and 30 systemic inflammatory response syndrome (SIRS) patients with no sepsis diagnosed. Serum levels of sCD163, procalcitonon (PCT), and C reactive protein (CRP) were determined respectively. Sequential organ failure assessment (SOFA) scores for sepsis patients were also recorded. Then evaluated their roles in sepsis.
The sCD163 levels were 0.88(0.78-1.00) ug/mL for SIRS patients, 1.50(0.92-2.00) ug/mL for moderate sepsis patients, and 2.95(2.18-5.57) ug/mL for severe sepsis patients on day 1. The areas under the ROC curves for sCD163, CRP, and PCT for the diagnosis of sepsis were, respectively, 0.856(95%CI: 0.791-0.921), 0.696(95%CI: 0.595-0.797), and 0.629(95%CI: 0.495-0.763), At the recommended cut-off 1.49 ug/mL for sCD163, the sensitivity is 74.0% with 93.3% specificity. Based on 28-day survivals, sCD163 levels in the surviving group stay constant, while they tended to gradually increase in the non-surviving group.The area under the ROC curve for sCD163 for sepsis prognosis was 0.706(95%CI 0.558-0.804). Levels of sCD163 with cut-off point >2.84 ug/mL have sensitivity of 55.8.0%, specificity 80.4%. Common risk factors for death and sCD163 were included in multivariate logistic regression analysis; the odds ratios (OR) for sCD163 and SOFA scores for sepsis prognosis were 1.173 and 1.396, respectively (P<0.05). Spearman rank correlation analysis showed that sCD163 was weakly, but positively correlated with CRP, PCT, and SOFA scores (0.2< r <0.4, P<0.0001), but not with leukocyte counts (r <0.2, P = 0.450).
Serum sCD163 is superior to PCT and CRP for the diagnosis of sepsis and differentiate the severity of sepsis. sCD163 levels were more sensitive for dynamic evaluations of sepsis prognosis. Serum sCD163 and SOFA scores are prognostic factors for sepsis.
我们旨在研究血清可溶性 CD163（sCD163）在重症患者脓毒症的诊断、严重程度评估和预后中的作用，并将 sCD163 与其他感染相关变量进行比较。
2010 年 7 月至 2011 年 4 月，纳入 102 例脓毒症患者（入院后 ICU 第 1、3、5、7 和 10 天）和 30 例全身炎症反应综合征（SIRS）患者（无脓毒症诊断），检测血清 sCD163、降钙素原（PCT）和 C 反应蛋白（CRP）水平，记录脓毒症患者的序贯器官衰竭评估（SOFA）评分，评估其在脓毒症中的作用。
SIRS 患者的 sCD163 水平为 0.88（0.78-1.00）μg/ml，中度脓毒症患者为 1.50（0.92-2.00）μg/ml，严重脓毒症患者为 2.95（2.18-5.57）μg/ml。sCD163、CRP 和 PCT 对脓毒症诊断的 ROC 曲线下面积分别为 0.856（95%CI：0.791-0.921）、0.696（95%CI：0.595-0.797）和 0.629（95%CI：0.495-0.763）。sCD163 的推荐截断值为 1.49μg/ml，其敏感性为 74.0%，特异性为 93.3%。根据 28 天存活率，存活组的 sCD163 水平保持不变，而在非存活组中 sCD163 水平趋于逐渐升高。sCD163 对脓毒症预后的 ROC 曲线下面积为 0.706（95%CI 0.558-0.804）。sCD163 截断值>2.84μg/ml 的敏感性为 55.8.0%，特异性为 80.4%。多变量逻辑回归分析纳入了死亡和 sCD163 的常见危险因素；sCD163 和 SOFA 评分对脓毒症预后的比值比（OR）分别为 1.173 和 1.396（P<0.05）。Spearman 秩相关分析表明，sCD163 与 CRP、PCT 和 SOFA 评分呈弱正相关（0.2< r <0.4，P<0.0001），但与白细胞计数无相关性（r <0.2，P = 0.450）。
血清 sCD163 对脓毒症的诊断优于 PCT 和 CRP，可区分脓毒症的严重程度。sCD163 水平对脓毒症预后的动态评估更敏感。血清 sCD163 和 SOFA 评分是脓毒症的预后因素。
