Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.
Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany.
PLoS One. 2020 Sep 3;15(9):e0238587. doi: 10.1371/journal.pone.0238587. eCollection 2020.
We aimed to evaluate the effects of combining the Simplified-Acute-Physiology-Score (SAPS) 2 or the SAPS 3 with Interleukin-6 (IL-6) or Procalcitonin (PCT) or C-Reactive Protein (CRP) concentrations for predicting in-hospital mortality.
This retrospective study was conducted in an interdisciplinary 22-bed intensive care unit (ICU) at a German university hospital. Within an 18-month period, SAPS 2 and SAPS 3 were calculated for 514 critically ill patients that were admitted to the internal medicine department. To evaluate discrimination performance, the area under the receiver operating characteristic curves (AUROCs) and the 95% confidence intervals (95% CIs) were calculated for each score, exclusively or in combination with IL-6 or PCT or CRP. DeLong test was used to compare different AUROCs.
The SAPS 2 exhibited a better discrimination performance than SAPS 3 with AUROCs of 0.81 (95% CI, 0.76-0.86) and 0.72 (95% CI, 0.66-0.78), respectively. Overall, combination of the SAPS 2 with IL-6 showed the best discrimination performance (AUROC 0.82; 95% CI, 0.77-0.87), albeit not significantly different from SAPS2. IL-6 performed better than PCT and CRP with AUROCs of 0.75 (95% CI, 0.69-0.81), 0.72 (95% CI, 0.66-0.77) and 0.65 (95% CI, 0.59-0.72), respectively. Performance of the SAPS 3 improved significantly when combined with IL-6 (AUROC 0.76; 95% CI, 0.69-0.81) or PCT (AUROC 0.73; 95% CI, 0.67-0.78).
Our analysis provided evidence that the risk stratification performance of the SAPS 3 and, to a lesser degree, also of the SAPS 2 can increase when combined with IL-6. A more accurate detection of aberrant or dysregulated systemic immunological responses (by IL-6) may explain the higher performance achieved by SAPS 3 + IL-6 vs. SAPS 3. Thus, implementation of IL-6 in critical care scores can improve prediction outcomes, especially in patients experiencing acute inflammatory conditions; however, statistical results may vary across hospital types and/or patient populations with different case mix.
我们旨在评估将简化急性生理学评分（SAPS）2 或 SAPS 3 与白细胞介素 6（IL-6）或降钙素原（PCT）或 C 反应蛋白（CRP）浓度相结合，预测住院死亡率的效果。
这是一项在德国一所大学医院的跨学科 22 张病床的重症监护病房（ICU）进行的回顾性研究。在 18 个月的时间里，为内科收治的 514 名危重症患者计算了 SAPS 2 和 SAPS 3。为了评估判别性能，分别计算了每个评分的受试者工作特征曲线（ROC）下面积（AUROC）及其 95%置信区间（95%CI），并单独或结合 IL-6 或 PCT 或 CRP 进行评估。使用 DeLong 检验比较不同的 AUROCs。
SAPS 2 的判别性能优于 SAPS 3，AUROC 分别为 0.81（95%CI，0.76-0.86）和 0.72（95%CI，0.66-0.78）。总体而言，SAPS 2 联合 IL-6 的组合表现出最佳的判别性能（AUROC 0.82；95%CI，0.77-0.87），尽管与 SAPS2 相比并无显著差异。IL-6 的 AUROC 分别为 0.75（95%CI，0.69-0.81）、0.72（95%CI，0.66-0.77）和 0.65（95%CI，0.59-0.72），优于 PCT 和 CRP，表现更好。当与 IL-6（AUROC 0.76；95%CI，0.69-0.81）或 PCT（AUROC 0.73；95%CI，0.67-0.78）联合使用时，SAPS 3 的性能显著提高。
我们的分析结果表明，SAPS 3 的风险分层性能（在较小程度上，SAPS 2 也是如此）在与 IL-6 联合使用时可以提高。更准确地检测异常或失调的全身免疫反应（通过 IL-6）可能解释了 SAPS 3+IL-6 与 SAPS 3 相比所取得的更高性能。因此，在重症监护评分中实施 IL-6 可以改善预测结果，特别是在患有急性炎症性疾病的患者中；然而，统计结果可能因医院类型和/或具有不同病例组合的患者人群而异。
