Liu Qin, Fan Xiaoguang, Cui Wenjuan, Wang Xincheng, Zhang Zhaolong, Wang Naizhi, Qiao Lujun
Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China.
Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital, Dongying, China.
Turk J Anaesthesiol Reanim. 2023 Oct 24;51(5):408-413. doi: 10.4274/TJAR.2023.231349.
The prognostic utility of inflammatory markers in survival has been suggested in patients with cancer; however, evidence on their prognostic value in severely ill patients is very limited. We aimed to explore the prognostic value of cholinesterase (ChE), C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) in predicting mortality in patients from the intensive care unit (ICU).
Serum levels of ChE, CRP, IL-6 and PCT were measured in ICU patients from December 13, 2019 to June 28, 2022. We assessed the predictive power of ChE, CRP, IL-6, and PCT using the receiver operating characteristic (ROC) curves. Furthermore, we evaluated their diagnostic accuracy by comparing the areas under the ROC curve (AUCs) along with their corresponding 95% confidence intervals (CIs). The cut-off values were determined to dichotomise these biomarkers, which were then included in multivariable logistic regression models to examine their relationship with ICU mortality.
Among 253 ICU patients included in the study, 66 (26%) died during the ICU stay. The AUCs to predict ICU mortality were 0.643 (95% CI, 0.566-0.719), 0.648 (95% CI, 0.633-0.735), 0.643 (95% CI, 0.563-0.723) and 0.735 (95% CI, 0.664-0.807) for ChE, CRP, IL-6 and PCT, respectively. After adjusting for age, sex and disease severity, lower ChE level (<3.668 × 10 U L) and higher levels of CRP (>10.546 mg dL), IL-6 (>986.245 pg mL) and PCT (>0.505 μg L) were associated with higher mortality risk, with odd ratios of 2.70 (95% CI, 1.32-5.54), 4.99 (95% CI, 2.41-10.38), 3.24 (95% CI, 1.54-6.78) and 3.67 (95% CI, 1.45-9.95), respectively.
ChE, CRP, IL-6 and PCT were independent ICU mortality risk factors in severely ill patients. Elevated PCT levels exhibited better predictive value than the other three biomarkers that were evaluated.
已有研究表明炎症标志物对癌症患者的生存具有预后评估作用；然而，关于其在重症患者中的预后价值的证据非常有限。我们旨在探讨胆碱酯酶（ChE）、C反应蛋白（CRP）、白细胞介素-6（IL-6）和降钙素原（PCT）在预测重症监护病房（ICU）患者死亡率方面的预后价值。
对2019年12月13日至2022年6月28日期间入住ICU的患者测定其血清ChE、CRP、IL-6和PCT水平。我们使用受试者工作特征（ROC）曲线评估ChE、CRP、IL-6和PCT的预测能力。此外，我们通过比较ROC曲线下面积（AUC）及其相应的95%置信区间（CI）来评估它们的诊断准确性。确定这些生物标志物的截断值以进行二分法分析，然后将其纳入多变量逻辑回归模型以检验它们与ICU死亡率的关系。
在纳入研究的253例ICU患者中，66例（26%）在ICU住院期间死亡。ChE、CRP、IL-6和PCT预测ICU死亡率的AUC分别为0.643（95%CI，0.566 - 0.719）、C0.648（95%CI，0.633 - 0.735）、0.643（95%CI，0.563 - 0.723）和0.735（95%CI，0.664 - 0.807）。在调整年龄、性别和疾病严重程度后，较低的ChE水平（<3.668×10 U/L）以及较高的CRP水平（>10.546 mg/dL）、IL-6水平（>986.245 pg/mL）和PCT水平（>0.505 μg/L）与较高的死亡风险相关，其比值比分别为2.70（95%CI，1.32 - 5.54）、4.99（95%CI，2.41 - 10.38）、3.24（95%CI，1.54 - 6.78）和3.67（95%CI，1.45 - 9.95）。
ChE、CRP、IL-6和PCT是重症患者独立的ICU死亡风险因素。与其他三种评估的生物标志物相比，升高的PCT水平表现出更好的预测价值。
