Yan Yamin, Hu Yan, Wang Xiaorong, Yu Zhenghong, Tang Yingjia, Zhang Yuxia, Pan Wenyan
Nursing Department, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Transl Med. 2021 Jan;9(1):56. doi: 10.21037/atm-20-6608.
The pathophysiological roles of serum cytokine levels in critically ill surgical patients has yet to be determined. This study aimed to determine the predictive prognostic values of serum interleukin IL-2, IL-6, IL-8, tumor necrosis factor-α (TNF-α), and procalcitonin (PCT) in surgical intensive care unit (ICU) patients.
Cytokine concentrations were measured with an IMMULITE 1000 Immunoassay System (Siemens Healthcare Diagnostics GmbH, Berlin, Germany). The study population was divided into quartiles according to the patients' cytokine levels: Q1, Q2, Q3, and Q4. The optimal cutoff values of IL-2, IL-6, IL-8, TNF-α, and PCT level for predicting mortality were established by drawing receiver operating characteristic curves.
The levels of IL-2 in Q3 [odds ratio (OR) =4.434, 95% confidence intervals (95% CI): 1.527-12.874] and Q4 (OR =7.715, 95% CI: 2.744-21.693) were significantly higher than those in the Q1. The same results were noted in IL-6 and IL-8, and only Q4 (OR =2.383, 95% CI: 1.419-4.001) showed significance in the level of TNF-α. For IL-2, a cutoff value of 930.5 U/mL yielded a sensitivity of 69.39% and a specificity of 80.16% for the prediction of clinical outcome [area under the curve (AUC): 0.822; 95% CI: 0.789-0.855]. For IL-6, a cutoff value of 50.95 pg/mL showed discrimination ability, yielding a sensitivity of 71.43% and a specificity of 61.75% for (AUC: 0.704; 95% CI: 0.660-0.748). For IL-8, a cutoff value of 44.1 pg/mL yielded a sensitivity of 57.82% and a specificity of 79.58% for predicting clinical outcome (AUC: 0.753; 95% CI: 0.713-0.793). For TNF-α, a cutoff value of 11.95 pg/mL yielded a sensitivity and specificity of 68.66% and 72.90%, respectively, in predicting clinical outcome (AUC: 0.758; 95% CI: 0.717-0.800). The positive likelihood ratios for IL-2, IL-6, IL-8, and TNF-α were 3.50, 1.87, 2.83 and 2.53, and the negative likelihood ratios were 0.38, 0.46, 0.53, and 0.43, respectively.
In critically ill patients, high levels of IL-2, IL-6, IL-8, and TNF-α in the first 24 h postoperatively were associated with clinical outcome. However, the effect of PCT level on prognosis still requires further study.
血清细胞因子水平在重症外科患者中的病理生理作用尚未确定。本研究旨在确定血清白细胞介素IL-2、IL-6、IL-8、肿瘤坏死因子-α（TNF-α）和降钙素原（PCT）对外科重症监护病房（ICU）患者的预测预后价值。
采用IMMULITE 1000免疫分析系统（德国柏林西门子医疗诊断有限公司）测量细胞因子浓度。根据患者的细胞因子水平将研究人群分为四分位数：Q1、Q2、Q3和Q4。通过绘制受试者工作特征曲线确定IL-2、IL-6、IL-8、TNF-α和PCT水平预测死亡率的最佳临界值。
Q3组[比值比（OR）=4.434，95%置信区间（95%CI）：1.527-12.874]和Q4组（OR =7.715，95%CI：2.744-21.693）的IL-2水平显著高于Q1组。IL-6和IL-8也有相同结果，且仅Q4组（OR =2.383，95%CI：1.419-4.001）的TNF-α水平具有显著性差异。对于IL-2，临界值为930.5 U/mL时，预测临床结局的敏感性为69.39%，特异性为80.16%[曲线下面积（AUC）：0.822；95%CI：0.789-0.855]。对于IL-6，临界值为50.95 pg/mL时具有鉴别能力，预测临床结局的敏感性为71.43%，特异性为61.75%（AUC：0.704；95%CI：0.660-0.748）。对于IL-8，临界值为44.1 pg/mL时，预测临床结局的敏感性为57.82%，特异性为79.58%（AUC：0.753；95%CI：0.713-0.793）。对于TNF-α，临界值为11.95 pg/mL时，预测临床结局的敏感性和特异性分别为68.66%和72.90%（AUC：0.758；95%CI：0.717-0.800）。IL-2、IL-6、IL-8和TNF-α的阳性似然比分别为3.50、1.87、2.83和2.53，阴性似然比分别为0.38、0.46、0.53和0.43。
在重症患者中，术后24小时内高水平的IL-2、IL-6、IL-8和TNF-α与临床结局相关。然而，PCT水平对预后的影响仍需进一步研究。
