中性粒细胞CD64、C反应蛋白和降钙素原作为脓毒症/脓毒性休克重症患者预后标志物的连续变化趋势：一项来自三级医疗重症监护病房的前瞻性观察研究
Serial Trend of Neutrophil CD64, C-reactive Protein, and Procalcitonin as a Prognostic Marker in Critically Ill Patients with Sepsis/Septic Shock: A Prospective Observational Study from a Tertiary Care ICU.
作者信息
Patnaik Rupali, Azim Afzal, Singh Kritika, Agarwal Vikas, Mishra Prabhaker, Poddar Banani, Gurjar Mohan, Mishra Shakti B
机构信息
Department of Critical Care Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India.
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
出版信息
Indian J Crit Care Med. 2024 Aug;28(8):777-784. doi: 10.5005/jp-journals-10071-24777. Epub 2024 Jul 31.
AIM AND BACKGROUND
Neutrophil CD64 (nCD64) is evolving as a prognostic biomarker in sepsis. The primary objective of this study was to evaluate whether serial trend of nCD64, procalcitonin (PCT), and C-reactive protein (CRP) predict 28-day mortality in patients with sepsis/septic shock, as per Sepsis-3 criteria.
MATERIALS AND METHODS
This prospective, observational single-center cohort study included 60 adult patients (age ≥18 years) with sepsis. Serial biomarker levels with SOFA score were measured at admission (day 0), on day 4, and on day 8.
RESULTS
Of the 60 patients, 42 (70%) had septic shock. Biomarker levels at admission did not differ between patients with sepsis and septic shock. Thirty-seven patients survived and 23 were non-survivors by day 28. There was a significant fall in serial trend of all three biomarkers from admission till day 8 (Friedman < 0.001) in survivors compared to a non-significant change in non-survivors. On multivariate analysis, SOFA score at admission (OR 1.731), more days with vasopressor support (OR 1.077), rise in CD64 from day 0 to day 8 (OR 1.074), and rise in CRP from day 0 to 8 (OR 1.245) were the significant predictors of 28-day mortality ( < 0.05). The highest area under the ROC curve was obtained for more days of vasopressor therapy (0.857), followed by a rise in CD64 from day 0 to day 8 (0.798).
CONCLUSION
Serial trend of biomarkers has prognostic utility. The rise in CD64 from day 0 to day 8 was a good predictor of mortality compared to the trend of other biomarkers.
HOW TO CITE THIS ARTICLE
Patnaik R, Azim A, Singh K, Agarwal V, Mishra P, Poddar B, . Serial Trend of Neutrophil CD64, C-reactive Protein, and Procalcitonin as a Prognostic Marker in Critically Ill Patients with Sepsis/Septic Shock: A Prospective Observational Study from a Tertiary Care ICU. Indian J Crit Care Med 2024;28(8):777-784.
目的与背景
中性粒细胞CD64（nCD64）正逐渐成为脓毒症的一种预后生物标志物。本研究的主要目的是根据脓毒症3.0标准，评估nCD64、降钙素原（PCT）和C反应蛋白（CRP）的连续变化趋势是否能预测脓毒症/脓毒性休克患者的28天死亡率。
材料与方法
这项前瞻性、观察性单中心队列研究纳入了60例成年脓毒症患者（年龄≥18岁）。在入院时（第0天）、第4天和第8天测量生物标志物水平及序贯器官衰竭评估（SOFA）评分。
结果
60例患者中，42例（70%）发生脓毒性休克。脓毒症患者和脓毒性休克患者入院时的生物标志物水平无差异。到第28天，37例患者存活，23例死亡。与非存活者无显著变化相比，存活者从入院到第8天这三种生物标志物的连续变化趋势均显著下降（Friedman检验P<0.001）。多因素分析显示，入院时的SOFA评分（比值比[OR]1.731）、使用血管活性药物支持的天数更多（OR 1.077）、CD64从第0天到第8天的升高（OR 1.074）以及CRP从第0天到第8天的升高（OR 1.245）是28天死亡率的显著预测因素（P<0.05）。血管活性药物治疗天数更多的受试者工作特征（ROC）曲线下面积最大（0.857），其次是CD64从第0天到第8天的升高（0.798）。
结论
生物标志物的连续变化趋势具有预后价值。与其他生物标志物的变化趋势相比，CD64从第0天到第8天的升高是死亡率的良好预测指标。
如何引用本文
帕特纳伊克R，阿齐姆A，辛格K，阿加瓦尔V，米什拉P，波达尔B等。中性粒细胞CD64、C反应蛋白和降钙素原的连续变化趋势作为脓毒症/脓毒性休克重症患者的预后标志物：一项来自三级医疗重症监护病房的前瞻性观察研究。《印度重症监护医学杂志》2024；28（8）：777 - 784。
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