Šundalić Sara, Košuta Iva, Baršić Lapić Ivana, Rako Ivana, Rogić Dunja, Radonić Radovan, Vujaklija Brajković Ana
Department of Internal Medicine, Division of Intensive Care Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia.
Medicina (Kaunas). 2025 Mar 7;61(3):468. doi: 10.3390/medicina61030468.
Sepsis still represents a syndrome with a high mortality. A timely sepsis diagnosis and an early intervention are crucial for the disease outcomes. Sepsis-associated acute kidney injury (SA-AKI) is highly prevalent but often diagnosed late. We aimed to investigate whether serum interleukin-6 (IL-6) and leukocyte cell population data (CPD) could be adequate biomarkers for the prediction of survival and SA-AKI development. We conducted a prospective observational study in a medical intensive care unit of a tertiary hospital centre in Zagreb, Croatia from June 2020 to October 2023. Adult patients with newly diagnosed sepsis were included and classified as immunocompetent or immunocompromised. Blood samples were collected upon admission. A total of 150 patients were included in the study. Ninety-six (64%) patients were immunocompetent and fifty-four (36%) were immunocompromised. The median SOFA score was 8 (6-11). SA-AKI was diagnosed in 108 (72%) patients. ICU and hospital mortality was 27.3% and 37.3%, with no significant difference between groups. Significantly higher serum IL-6 levels were noted in the immunocompromised group, while neutrophil granularity intensity was higher in the immunocompetent group. According to logistic regression analyses, elevated IL-6 levels predicted a lethal ICU outcome, while elevated IL-6 levels and neutrophil reactivity intensity were predictors of SA-AKI development. A cluster analysis revealed two patient groups with different IL-6 concentrations, and further studies indicated that the group with higher IL-6 values had significantly higher SA-AKI occurrence and increased lethal outcomes. An early serum IL-6 measurement regardless of the patients' immune status indicates disease severity. Its measurement in the early phase of disease presentation, potentially in the emergency department, might facilitate ICU admission. Further research is warranted in the field of leukocyte CDP application.
脓毒症仍然是一种死亡率很高的综合征。及时的脓毒症诊断和早期干预对疾病转归至关重要。脓毒症相关急性肾损伤(SA-AKI)非常普遍,但往往诊断较晚。我们旨在研究血清白细胞介素-6(IL-6)和白细胞细胞群体数据(CPD)是否可以作为预测生存和SA-AKI发生的合适生物标志物。我们于2020年6月至2023年10月在克罗地亚萨格勒布一家三级医院中心的医疗重症监护病房进行了一项前瞻性观察性研究。纳入新诊断为脓毒症的成年患者,并将其分为免疫功能正常或免疫功能低下组。入院时采集血样。共有150例患者纳入研究。96例(64%)患者免疫功能正常,54例(36%)患者免疫功能低下。SOFA评分中位数为8(6-11)。108例(72%)患者诊断为SA-AKI。ICU死亡率和医院死亡率分别为27.3%和37.3%,两组之间无显著差异。免疫功能低下组血清IL-6水平显著更高,而免疫功能正常组中性粒细胞颗粒度强度更高。根据逻辑回归分析,IL-6水平升高预示着ICU致命结局,而IL-6水平升高和中性粒细胞反应性强度是SA-AKI发生的预测因素。聚类分析显示有两个IL-6浓度不同的患者组,进一步研究表明IL-6值较高的组SA-AKI发生率显著更高且致命结局增加。无论患者免疫状态如何,早期检测血清IL-6可表明疾病严重程度。在疾病出现的早期阶段(可能在急诊科)进行检测可能有助于入住ICU。白细胞CDP应用领域有必要进行进一步研究。
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