Zhang Yi, Zhu Fengxue, Du Weihuan, He Yongmei, Guo Li, Yan Zhihong, Ji Hong
Department of Gereology, Aerospace Center Hospital, Beijing 100049, China (Zhang Y, Du WH, He YM, Guo L, Yan ZH, Ji H); Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China (Zhu FX). Corresponding author: Ji Hong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Aug;29(8):679-683. doi: 10.3760/cma.j.issn.2095-4352.2017.08.002.
To investigate the predicting value of intermedin (IMD) for the prognosis of elderly sepsis patients.
A retrospective analysis was conducted. Forty-one patients with sepsis, aged ≥65 years, and admitted to geriatrics intensive care unit of Aerospace Center Hospital from April 2015 to December 2016 were enrolled. Thirty healthy patients were studied as control during the same time. The expression of C-reactive protein (CRP), procalcitonin (PCT) and IMD were tested within 24 hours during hospitalization, and the acute physiology and chronic health evaluation II (APACHE II) score and prognosis was evaluated. According to APACHE II score, patients were divided into 3 groups, 10-20 score, 21-30 score, and > 30 score group. And based on the prognosis, the patients were divided into death group and survival group. The differences of expression levels of CRP, PCT and IMD in each group were assessed. The relationship of IMD and infection index was analyzed by Pearson correlation. Receiver operating characteristic curve (ROC) was used to evaluate the prognostic value of CRP, PCT and IMD in patients with sepsis.
Compared with the control group, the levels of CRP, PCT and IMD were significantly higher in the sepsis patients [CRP (mg/L): 114.71±40.08 vs. 4.03±2.68, PCT (μg/L): 1.338±0.812 vs. 0.007±0.001, IMD (ng/L): 43.03±9.67 vs. 16.77±2.06, all P < 0.01]. With the increase of APACHE II score, the levels of PCT and IMD were gradually increased. In APACHE II 10-20 score, 21-30 score, > 30 score groups, PCT (μg/L) were 0.397±0.129, 1.164±0.326, and 1.999±0.888, respectively (F = 19.392, P = 0.000); IMD (ng/L) were 29.12±5.60, 40.48±4.40, 52.75±4.73, respectively (F = 33.310, P = 0.000). There was no significant difference in CRP among APACHE II score groups (F = 2.137, P = 0.132). The level of IMD was positively correlated with CRP and PCT (r = 0.351, P = 0.024; r = 0.617, P = 0.000), and there was no correlation with temperature and white blood cell count (r = 0.063, P = 0.697; r = 0.064, P = 0.692). The expression of PCT and IMD in the death groups were significantly higher than the survival group [PCT (μg/L): 1.547±0.883 vs. 1.043±0.608, IMD (ng/L): 47.44±8.23 vs. 36.80±8.13, both P < 0.05], while CRP was not significantly different. The area under the ROC curve [AUC (95% confidence interval, 95%CI)] of IMD was larger than that of PCT and CRP [0.809 (0.675-0.943) vs. 0.680 (0.511-0.849), 0.664 (0.490-0.838)]; when cut-off value of IMD was 41.58 ng/L, the sensitivity was 75.0% and the specificity was 82.4%.
The levels of CRP, PCT and IMD were increased in elderly sepsis patients, and IMD and PCT can better reflect the severity of sepsis. IMD is more valuable in predicting the prognosis of sepsis patients.
探讨中间介质（IMD）对老年脓毒症患者预后的预测价值。
进行回顾性分析。纳入2015年4月至2016年12月在航天中心医院老年重症监护病房收治的41例年龄≥65岁的脓毒症患者。同期选取30例健康患者作为对照。在住院24小时内检测C反应蛋白（CRP）、降钙素原（PCT）和IMD的表达，并评估急性生理与慢性健康状况评分系统II（APACHE II）评分及预后。根据APACHE II评分，将患者分为3组，即10 - 20分、21 - 30分和>30分组。根据预后情况，将患者分为死亡组和存活组。评估每组中CRP、PCT和IMD表达水平的差异。采用Pearson相关性分析IMD与感染指标的关系。应用受试者工作特征曲线（ROC）评估CRP、PCT和IMD对脓毒症患者的预后价值。
与对照组相比，脓毒症患者的CRP、PCT和IMD水平显著升高[CRP（mg/L）：114.71±40.08 vs. 4.03±2.68，PCT（μg/L）：1.338±0.812 vs. 0.007±0.001，IMD（ng/L）：43.03±9.67 vs. 16.77±2.06，P均<0.01]。随着APACHE II评分的增加，PCT和IMD水平逐渐升高。在APACHE II 10 - 20分、21 - 30分、>30分组中，PCT（μg/L）分别为0.39 ± 0.129、1.164 ± 0.326和1.999 ± 0.888（F = 19.392，P = 0.000）；IMD（ng/L）分别为29.12 ± 5.60、40.48 ± 4.40和52.75 ± 4.73（F = 33.310，P = 0.000）。APACHE II评分组间CRP无显著差异（F = 2.137，P = 0.132）。IMD水平与CRP和PCT呈正相关（r = 0.351，P = 0.024；r = 0.617，P = 0.000），与体温和白细胞计数无相关性（r = 0.063，P = 0.697；r = 0.064，P = 0.692）。死亡组中PCT和IMD的表达显著高于存活组[PCT（μg/L）：1.547 ± 0.883 vs. 1.043 ± 0.608，IMD（ng/L）：47.44 ± 8.23 vs. 36.80 ± 8.13，P均<0.05]，而CRP无显著差异。IMD的ROC曲线下面积[AUC（95%置信区间，95%CI）]大于PCT和CRP[0.809（0.675 - 0.943）vs. 0.680（0.511 - 0.849），0.664（0.490 - 0.838）]；当IMD的截断值为41.58 ng/L时，敏感性为75.0%，特异性为82.4%。
老年脓毒症患者的CRP、PCT和IMD水平升高，且IMD和PCT能更好地反映脓毒症的严重程度。IMD在预测脓毒症患者预后方面更具价值。
