Laboratory Department, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China (mainland).
Emergency Department, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China (mainland).
Med Sci Monit. 2021 Feb 25;27:e929527. doi: 10.12659/MSM.929527.
BACKGROUND Our aim was to determine a useful combination of blood biomarkers that can predict 28-day mortality of sepsis upon arrival at the Emergency Department (ED). MATERIAL AND METHODS Based on Sepsis-3.0, 90 sepsis patients were enrolled and divided into survivor and nonsurvivor groups with day 28 as the study end point. After comparing the demographic data and clinical characteristics of patients, we evaluated the predictive validity of a combination of markers including interleukin-6 (IL-6), procalcitonin (PCT), and lactate at arrival at the ED. Independent risk factors were found by using univariate and multivariate logistic regression analyses, and the prognostic value of markers was determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS There were 67 (74.4%) survivors and 23 (25.6%) nonsurvivors. The levels of IL-6 (survivors vs nonsurvivors: median 205.30 vs 3499.00 pg/mL, P=0.012) and lactate (survivors vs. nonsurvivors: median 2.37 vs 5.77 mmol/L, P=0.003) were significantly lower in survivor group compared with the nonsurvivor group. Markers including IL-6, PCT, lactate, and neutrophil-to-white blood cell ratio (NWR) were independent risk factors in predicting 28-day mortality due to sepsis. The combination of these 4 markers provided the best predictive performance for 28-day mortality of patients with sepsis, on arrival at the ED (AUC of 0.823, 95% confidence interval [CI] 0.723-0.924), and its accuracy, specificity, and sensitivity were 74.4% (95% CI 64.0-82.8%), 91% (95% CI 80.9-96.3%), and 65% (95% CI 42.8-82.8%), respectively. CONCLUSIONS The combination of IL-6, PCT, lactate, and NWR measurements is a potential predictor of 28-day mortality for patients with sepsis, at arrival at the ED. Further research is needed to confirm our findings.
我们的目的是确定一组有用的血液生物标志物，以预测到达急诊部（ED）时败血症的 28 天死亡率。
基于 Sepsis-3.0，纳入了 90 名败血症患者，并将其分为存活组和非存活组，以 28 天为研究终点。在比较患者的人口统计学数据和临床特征后，我们评估了白细胞介素-6（IL-6）、降钙素原（PCT）和乳酸在到达 ED 时的组合标志物的预测有效性。使用单变量和多变量逻辑回归分析确定独立危险因素，并通过接收者操作特征（ROC）曲线的曲线下面积（AUC）确定标志物的预后价值。
共有 67 名（74.4%）患者存活，23 名（25.6%）患者死亡。IL-6（存活组 vs 非存活组：中位数 205.30 与 3499.00 pg/mL，P=0.012）和乳酸（存活组 vs 非存活组：中位数 2.37 与 5.77 mmol/L，P=0.003）水平在存活组中明显低于非存活组。IL-6、PCT、乳酸和中性粒细胞与白细胞比值（NWR）是预测败血症 28 天死亡率的独立危险因素。这些标志物的组合在预测败血症患者到达 ED 时的 28 天死亡率方面提供了最佳的预测性能（AUC 为 0.823，95%置信区间 [CI] 0.723-0.924），其准确性、特异性和敏感度分别为 74.4%（95% CI 64.0-82.8%）、91%（95% CI 80.9-96.3%）和 65%（95% CI 42.8-82.8%）。
IL-6、PCT、乳酸和 NWR 测量的组合是预测到达 ED 的败血症患者 28 天死亡率的潜在指标。需要进一步的研究来证实我们的发现。
