白细胞介素 6 可改善疑似脓毒症患者评估中医生判断时的感染识别能力。
Interleukin-6 improves infection identification when added to physician judgment during evaluation of potentially septic patients.
机构信息
Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America.
Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America.
出版信息
Am J Emerg Med. 2020 May;38(5):947-952. doi: 10.1016/j.ajem.2019.158361. Epub 2019 Jul 25.
BACKGROUND
Identifying infection is critical in early sepsis screening. This study assessed whether biomarkers of endothelial activation and/or inflammation could improve identification of infection among Emergency Department (ED) patients with organ dysfunction.
METHODS
We performed a prospective, observational study at two urban, academic EDs, between June 2016 and December 2017. We included admitted adults with 1) two systemic inflammatory response syndrome criteria and organ dysfunction, 2) systolic blood pressure < 90 mmHg, or 3) lactate ≥4.0 mmol/L. We excluded patients with trauma, transferred for intracranial hemorrhage, or without available blood samples. Treating ED physicians reported presence of infection (yes/no) at inpatient admission. Assays for angiopoietin-1, angiopoietin-2, soluble tumor necrosis factor receptor-1, interleukin-6, and interleukin-8 were performed using ED blood samples. The primary outcome was infection, adjudicated by paired physician review. Using logistic regression, we compared the performance of physician judgment, biomarkers, and physician judgment-biomarkers combination to predict infection. Area under the curve (AUC) and AUC 95% confidence intervals were estimated by bootstrap procedure.
RESULTS
Of 421 patients enrolled, 306 patients met final study criteria. Of these, 154(50.3%) patients had infectious etiologies. Physicians correctly discriminated infectious from non-infectious etiologies in 239 (78.1%). Physician judgment performed moderately when discriminating infection (AUC 0.78, 95% CI: 0.74-0.82) and outperformed the best biomarker model, interleukin-6 alone, (AUC 0.71, 0.66-0.76). Physician judgment improved when including interleukin-6 (AUC 0.84, 0.79-0.87), with modest AUC improvement: 0.06 (0.03-0.08).
CONCLUSIONS
In ED patients with organ dysfunction, plasma interleukin-6 may improve infection discrimination when added to physician judgment.
背景
识别感染在早期脓毒症筛查中至关重要。本研究评估了内皮细胞激活和/或炎症的生物标志物是否可以改善对急诊科（ED）器官功能障碍患者感染的识别。
方法
我们在 2016 年 6 月至 2017 年 12 月期间在两家城市学术 ED 进行了一项前瞻性、观察性研究。我们纳入了以下住院患者：1）有两个全身炎症反应综合征标准和器官功能障碍，2）收缩压 <90mmHg，或 3）乳酸≥4.0mmol/L。我们排除了有创伤、因颅内出血转院或无可用血样的患者。急诊科医生在住院时报告患者是否存在感染（是/否）。使用 ED 血样检测血管生成素-1、血管生成素-2、可溶性肿瘤坏死因子受体-1、白细胞介素-6 和白细胞介素-8。主要结局是感染，通过配对医生审查确定。使用逻辑回归，我们比较了医生判断、生物标志物和医生判断-生物标志物组合预测感染的性能。通过自举程序估计曲线下面积（AUC）和 AUC95%置信区间。
结果
在纳入的 421 名患者中，有 306 名患者符合最终研究标准。其中，154 名（50.3%）患者的病因具有感染性。医生正确区分了感染性和非感染性病因，准确率为 239 名（78.1%）。医生判断在区分感染时表现中等（AUC 0.78，95%CI：0.74-0.82），优于最佳生物标志物模型白细胞介素-6 单独使用（AUC 0.71，0.66-0.76）。当包括白细胞介素-6 时，医生判断得到改善（AUC 0.84，0.79-0.87），AUC 略有改善：0.06（0.03-0.08）。
结论
在 ED 器官功能障碍患者中，当将白细胞介素-6 加入医生判断时，可能会改善对感染的鉴别。
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