重症患者中白细胞介素-6、中性粒细胞CD64表达、C反应蛋白和脂多糖结合蛋白的预后价值及每日变化趋势：是否为可靠的预后预测指标？

Prognostic Value and Daily Trend of Interleukin-6, Neutrophil CD64 Expression, C-Reactive Protein and Lipopolysaccharide-Binding Protein in Critically Ill Patients: Reliable Predictors of Outcome or Not?

作者信息

Djordjevic Dragan, Pejovic Janko, Surbatovic Maja, Jevdjic Jasna, Radakovic Sonja, Veljovic Milic, Peric Aneta, Andjelic Tamara, Popovic Nada

机构信息

Clinic of Anesthesiology and Intensive Therapy, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia.

Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia.

出版信息

J Med Biochem. 2015 Oct;34(4):431-439. doi: 10.1515/jomb-2015-0002. Epub 2015 Sep 19.

BACKGROUND

Severe sepsis and/or trauma complicated by multiple organ dysfunction syndrome are the leading causes of death in critically ill patients. The aim of this prospective single-centre study was to assess the prognostic value and daily trend of interleukin-6 (IL-6), neutrophil CD64 expression, C-reactive protein (CRP) and lipopolysaccharide-binding protein (LBP) regarding outcome in critically ill patients with severe trauma and/or severe sepsis. Outcome measure was hospital mortality.

METHODS

One hundred and two critically ill patients admitted to the intensive care unit of a tertiary university hospital were enrolled in this prospective study. Blood samples were collected on admission (day 1), days 2 and 3.

RESULTS

CD64 index was 1.6-fold higher on day 1 and 1.78-fold higher on day 2 in non-survivors (p<0.05). The area under the curve (AUC) for the CD64 index on day 1 for outcome was 0.727. At a cut-off level of 2.80 sensitivity was 75% and specificity was 65%. Patients with CD64 index level on day 1 higher than 2.80 had 2.4-fold higher probability of dying. Odds ratio is 2.40; 95% CI 0.60-9.67.

CONCLUSIONS

CD64 index on day 1 is a fairly good predictor of outcome. AUCs for IL-6, CRP and LBP were < 0.55, suggesting these biomarkers failed to predict outcome.

背景

严重脓毒症和/或创伤并发多器官功能障碍综合征是危重症患者死亡的主要原因。这项前瞻性单中心研究的目的是评估白细胞介素-6（IL-6）、中性粒细胞CD64表达、C反应蛋白（CRP）和脂多糖结合蛋白（LBP）对严重创伤和/或严重脓毒症危重症患者预后的预测价值及每日变化趋势。预后指标为医院死亡率。

方法

本前瞻性研究纳入了一所三级大学医院重症监护病房收治的102例危重症患者。在入院时（第1天）、第2天和第3天采集血样。

结果

非存活者第1天的CD64指数高1.6倍，第2天高1.78倍（p<0.05）。第1天CD64指数预测预后的曲线下面积（AUC）为0.727。截断值为2.80时，敏感度为75%，特异度为65%。第1天CD64指数水平高于2.80的患者死亡概率高2.4倍。比值比为2.40；95%可信区间为0.60 - 9.67。