Wang Xin, Li Ming, Yang Yang, Shang Xueyi, Wang Yonggang, Li Yan
Department of Critical Care Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, China.
Department of Clinical Laboratory, The First Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
Heliyon. 2024 Feb 22;10(5):e26873. doi: 10.1016/j.heliyon.2024.e26873. eCollection 2024 Mar 15.
In recent decades, there has been a notable increase in the morbidity and mortality rates linked to bacteremia and candidemia. This study aimed to investigate the clinical significance of inflammatory markers in assessing the disease severity in critically ill patients suffering from mixed-bloodstream infections (BSIs) due to spp. and spp.
In this retrospective research, patients diagnosed with BSIs who were admitted to the intensive care unit (ICU) during the period of January 2019 to December 2022 were analyzed. The patients were divided into two groups: a mixed-pathogen BSI group with both spp. and spp., and a single-pathogen BSI group with only spp. The study examined the differences in inflammatory marker levels and disease severity, including Acute Physiology and Chronic Health Evaluation (APACHE) II scores, duration of ICU stay, and 30-day mortality, between the two groups. Furthermore, we sought to scrutinize the potential associations among these aforementioned parameters.
The neutrophil-to-lymphocyte ratios (NLRs) and levels of plasma C-reactive protein (CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) in the mixed-pathogen BSI group were higher than those in the single-pathogen BSI group. Spearman's rank correlation analysis showed that NLRs and plasma CRP and IL-6 levels were positively correlated with disease severity in the mixed-pathogen BSI group. Further, the levels of plasma IL-8 and TNF-α were also positively correlated with ICU stay duration and 30-day mortality. In multivariate analysis, plasma CRP and IL-6 levels were independently associated with 30-day mortality.
Mixed-pathogen BSIs caused by spp. and spp. may give rise to increased NLRs and plasma CRP, IL-6, IL-8, and TNF-α levels in comparison to BSI caused by spp. only, thus leading to elevated disease severity in critically ill patients.
近几十年来，与菌血症和念珠菌血症相关的发病率和死亡率显著上升。本研究旨在探讨炎症标志物在评估因某菌属和另一菌属导致的混合血流感染（BSIs）的重症患者疾病严重程度方面的临床意义。
在这项回顾性研究中，分析了2019年1月至2022年12月期间入住重症监护病房（ICU）并被诊断为BSIs的患者。患者被分为两组：同时感染某菌属和另一菌属的混合病原体BSI组，以及仅感染某菌属的单病原体BSI组。该研究考察了两组之间炎症标志物水平和疾病严重程度的差异，包括急性生理与慢性健康状况评估（APACHE）II评分、ICU住院时间和30天死亡率。此外，我们试图仔细研究上述参数之间的潜在关联。
混合病原体BSI组的中性粒细胞与淋巴细胞比值（NLRs）以及血浆C反应蛋白（CRP）、白细胞介素（IL）-6、IL-8和肿瘤坏死因子-α（TNF-α）水平高于单病原体BSI组。Spearman等级相关分析表明，混合病原体BSI组中NLRs以及血浆CRP和IL-6水平与疾病严重程度呈正相关。此外，血浆IL-8和TNF-α水平也与ICU住院时间和30天死亡率呈正相关。在多变量分析中，血浆CRP和IL-6水平与30天死亡率独立相关。
与仅由某菌属引起的BSI相比，由某菌属和另一菌属导致的混合病原体BSIs可能会使NLRs以及血浆CRP、IL-6、IL-8和TNF-α水平升高，从而导致重症患者的疾病严重程度升高。
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