重新探讨单核细胞趋化蛋白 1 和白细胞介素-6 在 sepsis-3 时代的预后价值。

Revisiting the prognostic value of monocyte chemotactic protein 1 and interleukin-6 in the sepsis-3 era.

机构信息

From the First Department of Medicine (M.Ba., M.Be., S.H., D.P., D.L., S.L., I.A., M.Bo., U.H.), University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.

Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany.

出版信息

J Crit Care. 2018 Feb;43:21-28. doi: 10.1016/j.jcrc.2017.08.024. Epub 2017 Aug 15.

DOI:10.1016/j.jcrc.2017.08.024

PMID:28834779

Abstract

BACKGROUND

Monocyte Chemotactic Protein 1 (MCP1) and latest sepsis-3 criteria are poorly represented within studies evaluating biomarkers in sepsis. Therefore, this study evaluates the prognostic value of MCP-1 compared to interleukin-6 (IL-6) in patients with sepsis and septic shock according to sepsis-3 criteria.

METHODS

136 patients with sepsis or septic shock were included within 24h of intensive care unit (ICU) admission. MCP-1, IL-6, procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC) were measured on days 1, 3 and 8. All-cause mortality was followed up at 30days and 6months.

RESULTS

Both MCP-1 and IL-6 levels revealed valuable prognostic discrimination of 30-day and 6-months all-cause mortality on day 1 and 3 (MCP-1: range of AUCs 0.62-0.65, p<0.039; IL-6: range of AUCs 0.65-0.70, p<0.021) compared to PCT, CRP, SOFA and APACHE II score. MCP-1 levels within the 4th quartile revealed the highest mortality at 30days and 6months compared to patients with lower levels (range of hazard ratio (HR)=2.1-3.3, p<0.041). The prognostic value of MCP-1 sustained in multivariate regression models and was comparable to that of IL-6.

CONCLUSION

Both MCP-1 and IL-6 revealed prognostic value for short- and mid-term all-cause mortality in patients with sepsis and septic shock according to latest sepsis-3 definitions.

摘要

背景

单核细胞趋化蛋白 1（MCP1）和最新的脓毒症 3 标准在评估脓毒症生物标志物的研究中表现不佳。因此，本研究根据脓毒症 3 标准评估了 MCP-1 与白细胞介素 6（IL-6）在脓毒症和感染性休克患者中的预后价值。

方法

136 名脓毒症或感染性休克患者在重症监护病房（ICU）入院后 24 小时内被纳入研究。在第 1、3 和 8 天测量 MCP-1、IL-6、降钙素原（PCT）、C 反应蛋白（CRP）和白细胞（WBC）。在 30 天和 6 个月时对全因死亡率进行随访。

结果

在第 1 天和第 3 天，MCP-1 和 IL-6 水平对 30 天和 6 个月全因死亡率具有有价值的预后区分能力（MCP-1：AUC 范围 0.62-0.65，p<0.039；IL-6：AUC 范围 0.65-0.70，p<0.021），与 PCT、CRP、SOFA 和 APACHE II 评分相比。与较低水平的患者相比，第 4 四分位数的 MCP-1 水平在 30 天和 6 个月时显示出最高的死亡率（范围的风险比（HR）=2.1-3.3，p<0.041）。MCP-1 的预后价值在多变量回归模型中得到维持，与 IL-6 的预后价值相当。