Department of Critical Care, Faculty of Medicine, Marmara University, Istanbul, 34899, Turkey.
BMC Anesthesiol. 2023 Aug 17;23(1):278. doi: 10.1186/s12871-023-02237-3.
Sepsis and septic shock are disorders of tissue perfusion and microcirculation associated with increased mortality. The role of biomarkers such as proadrenomedullin (PRO-ADM), interleukin 6 (IL-6) and neutrophil CD64 (CD64) in the diagnosis and prognosis of septic shock has been studied.
GCS, SOFA score, APACHE 2 score, lactate, CRP, procalcitonin, PRO-ADM, IL-6, CD64 level and 28-day mortality were evaluated in patients with septic shock followed-up in the intensive care unit of Marmara University Hospital between July 2021 and December 2021. The study was planned as prospective, non-drug clinical research Committee.
There were no statistically significant differences between patient groups in gender, BMI, and presence of comorbidities (p > 0.05). The alive patient group had significantly higher GCS values and lower SOFA, APACHE 2, lactate and CD64 values than the dead patient group (p < 0.01). The cut-off values of laboratory parameters were determined using ROC analysis to predict mortality, SOFA and CD64 had high AUC. This is also a good indicator for mortality.The multivariate logistic regression model was estimated using the backward selection method. The mortality of ICU patients was predicted by a SOFA-value ≥ 12 (OR (95%CI) = 56.13 (5.44-578.64)), CD64 value ≥ 28.54 (OR (95% CI) = 23.78 (2.61-216.85)), and ADM-value ≥ 86.79 (OR (95% CI) = 15.86 (1.02-246.49)) (p < 0.05) .
In conclusion, serum CD64 level, PRO-ADM level, and SOFA score proved to be effective parameters for predicting prognosis and mortality in septic shock. However, IL-6 proved to be a weak biomarker and failed to predict mortality. CD64, which is easier and more practical to use, can be used instead of the SOFA score.
脓毒症和脓毒性休克是与组织灌注和微循环增加死亡率相关的疾病。已经研究了前肾上腺髓质素（PRO-ADM）、白细胞介素 6（IL-6）和中性粒细胞 CD64（CD64）等生物标志物在脓毒性休克诊断和预后中的作用。
评估了 2021 年 7 月至 2021 年 12 月在马尔马拉大学医院重症监护病房随访的脓毒性休克患者的 GCS、SOFA 评分、APACHE 2 评分、乳酸、CRP、降钙素原、PRO-ADM、IL-6、CD64 水平和 28 天死亡率。该研究计划为前瞻性、非药物临床研究委员会。
在性别、BMI 和合并症存在方面，患者组之间无统计学差异（p > 0.05）。存活患者组的 GCS 值明显高于死亡患者组，SOFA、APACHE 2、乳酸和 CD64 值明显低于死亡患者组（p < 0.01）。使用 ROC 分析确定实验室参数的临界值以预测死亡率，SOFA 和 CD64 具有较高的 AUC。这也是死亡率的一个很好指标。使用向后选择法估计多元逻辑回归模型。使用 SOFA 值≥12（OR（95%CI）=56.13（5.44-578.64））、CD64 值≥28.54（OR（95%CI）=23.78（2.61-216.85））和 ADM 值≥86.79（OR（95%CI）=15.86（1.02-246.49））预测 ICU 患者的死亡率（p < 0.05）。
总之，血清 CD64 水平、PRO-ADM 水平和 SOFA 评分被证明是预测脓毒性休克预后和死亡率的有效参数。然而，IL-6 被证明是一种弱生物标志物，无法预测死亡率。CD64 更简单实用，可以代替 SOFA 评分。
