全身免疫炎症值对感染性休克患者预后的重要性。

The prognostic importance of the pan-immune-inflammation value in patients with septic shock.

机构信息

Department of Critical Care, Marmara University Faculty of Medicine, Pendik, Istanbul, 34899, Turkey.

出版信息

BMC Infect Dis. 2024 Jan 10;24(1):69. doi: 10.1186/s12879-023-08963-w.

DOI:10.1186/s12879-023-08963-w

PMID:38200436

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10777599/

Abstract

INTRODUCTION

The purpose of this study was to determine whether the pan-immune-inflammation value (PIV), a novel biomarker combining neutrophil platelet, monocyte, and lymphocyte counts, some of the most widespread indicators of systemic inflammation, can predict mortality and prognosis in patients admitted to the intensive care unit (ICU) with septic shock.

METHOD

This prospective study was performed with 82 patients aged 18 or over admitted to a tertiary ICU with diagnoses of septic shock. Patients with hematological disease and neutropenia were excluded. PIV was calculated with the formula [neutrophil count (10/μL) × platelet count (10/μL) × monocyte count (10/μL)]/lymphocyte count (10/μL).

RESULTS

Median age, presence of hypertension, Acute Physiology and Chronic Health Evaluation II (APACHE II) levels, and neutrophil, monocyte, and platelet counts were lower in the low-PIV group than in the high-PIV group (p < 0.05). The highest area under ROC curve (AUC) was determined for Sequential Organ Failure Assessment (SOFA) (0.94 (0.89 - 0.99)), followed by Glasgow Coma Scale (GCS) (0.81 (0.70 - 0.91)), APACHE II (0.80 (0.69 - 0.91)) and lactate (0.77 (0.67 - 0.88)). Median survival was longer in the low-PIV group than in the high-PIV group (28 (15.25 - 40.76) vs 16 (9.46 - 22.55) days, respectively, p < 0.05). The univariate Cox proportional hazards (CPH) model showed that high PIV (HR = 2.13 (1.03-4.38)), low GCS (HR = 3.31 (1.34 - 8.15)), high SOFA (HR = 9.41 (2.86 - 30.95)), high APACHE II (HR = 3.08 (1.47 - 6.45)), high lactate (HR = 6.56 (2.73 - 15.75)), and high procalcitonin (PCT) (HR = 2.73 (1.11 - 6.69)) values were associated with a decreased survival time among ICU patients (p < 0.05). The multivariate CPH model showed the age-adjusted risk estimates for these six laboratory parameters. High lactate (HR = 7.97 (2.19 - 29.08)) and high SOFA scores (HR = 4.85 (1.22 - 19.32)) were significantly associated with shorter survival in ICU patients (p < 0.05).

CONCLUSION

The findings of this research suggest that PIV could predict the longer survival in patients with septic shock. Despite PIV score's capability to show inflammation, it is not significantly associated with mortality in the multivariate analysis.

摘要

简介

本研究旨在确定新型免疫炎症综合值（PIV）是否可以预测因败血症性休克而入住重症监护病房（ICU）的患者的死亡率和预后。PIV 是一种将中性粒细胞、血小板、单核细胞和淋巴细胞计数相结合的新型生物标志物，这些指标是最广泛的全身性炎症指标之一。

方法

本前瞻性研究纳入了 82 名年龄在 18 岁及以上的因败血症性休克而入住三级 ICU 的患者。排除了患有血液疾病和中性粒细胞减少症的患者。PIV 通过公式 [中性粒细胞计数（10/μL）×血小板计数（10/μL）×单核细胞计数（10/μL）]/淋巴细胞计数（10/μL）计算。

结果

低 PIV 组的中位年龄、高血压、急性生理学和慢性健康评估 II（APACHE II）水平以及中性粒细胞、单核细胞和血小板计数均低于高 PIV 组（p<0.05）。ROC 曲线下面积（AUC）最高的是序贯器官衰竭评估（SOFA）（0.94（0.89-0.99）），其次是格拉斯哥昏迷量表（GCS）（0.81（0.70-0.91））、APACHE II（0.80（0.69-0.91））和乳酸（0.77（0.67-0.88））。低 PIV 组的中位生存时间长于高 PIV 组（分别为 28（15.25-40.76）和 16（9.46-22.55）天，p<0.05）。单因素 Cox 比例风险（CPH）模型显示，高 PIV（HR=2.13（1.03-4.38））、低 GCS（HR=3.31（1.34-8.15））、高 SOFA（HR=9.41（2.86-30.95））、高 APACHE II（HR=3.08（1.47-6.45））、高乳酸（HR=6.56（2.73-15.75））和高降钙素原（PCT）（HR=2.73（1.11-6.69））与 ICU 患者的生存时间缩短相关（p<0.05）。多因素 CPH 模型显示了这六个实验室参数的年龄调整风险估计。高乳酸（HR=7.97（2.19-29.08））和高 SOFA 评分（HR=4.85（1.22-19.32））与 ICU 患者的生存时间缩短显著相关（p<0.05）。