中性粒细胞趋化活性作为免疫生物标志物预测严重脓毒症危重症患者死亡率的作用。

The role of neutrophil chemotaxis activity as an immunologic biomarker to predict mortality in critically-ill patients with severe sepsis.

机构信息

Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center for Critical Care Nephrology, The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Academic of Science, Royal Society of Thailand, Bangkok, Thailand; Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Excellence Center for Critical Care Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

出版信息

J Crit Care. 2020 Apr;56:215-221. doi: 10.1016/j.jcrc.2020.01.020. Epub 2020 Jan 17.

DOI:10.1016/j.jcrc.2020.01.020

PMID:31982695

Abstract

BACKGROUND

Innate immunity is an important host response to infection. However, the role of innate immunity as a prognostic biomarker in severe sepsis is still unknown. This study is to evaluate the discriminatory characteristics of these biomarkers on clinical outcome.

MATERIALS AND METHODS

Retrospective study was conducted in critically ill patients with severe sepsis. Neutrophil function was assessed by neutrophil chemotaxis activity and CD-11b expression. Monocyte function was assessed by measurement of mHLA-DR expression and presepsin level. The primary end point was 28 day-mortality.

RESULTS

A total of 136 participants were enrolled. Patients were classified into 2 groups as survivors (n = 63, 46.3%) and non-survivors (n = 73, 53.7%). Neutrophil chemotaxis activity was significantly higher in survivors (46.7% vs. 41.2%, p = .023). There was no difference in the remaining biomarker levels between survivors and non-survivors. Only decreased neutrophil chemotaxis activity was associated with 28-day mortality. Combining neutrophil chemotaxis activity with mHLA-DR, CD-11b expression, presepsin, and SOFA score provided the highest AUC of 0.90 (0.84-0.96) in predicting 28-day mortality.

CONCLUSION

Neutrophil chemotaxis activity appears to be a promising novel immunologic biomarker in predicting clinical outcome in patients with severe sepsis.

摘要

背景

先天免疫是宿主对感染的重要反应。然而，先天免疫作为严重脓毒症的预后生物标志物的作用尚不清楚。本研究旨在评估这些生物标志物对临床结局的鉴别特征。

材料与方法

对严重脓毒症的危重症患者进行回顾性研究。通过中性粒细胞趋化活性和 CD-11b 表达评估中性粒细胞功能。通过测量 mHLA-DR 表达和降钙素原水平评估单核细胞功能。主要终点为 28 天死亡率。

结果

共纳入 136 名参与者。将患者分为两组：幸存者（n=63，46.3%）和非幸存者（n=73，53.7%）。幸存者的中性粒细胞趋化活性明显更高（46.7% vs. 41.2%，p=0.023）。幸存者和非幸存者之间其余生物标志物水平无差异。只有中性粒细胞趋化活性降低与 28 天死亡率相关。将中性粒细胞趋化活性与 mHLA-DR、CD-11b 表达、降钙素原和 SOFA 评分相结合，预测 28 天死亡率的 AUC 最高为 0.90（0.84-0.96）。