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血清炎性标志物连续监测联合序贯器官衰竭评分对肺部感染所致脓毒症患者预后的评估价值

Evaluation of the prognosis of pneumonia induced sepsis by continuous detection of serum inflammatory markers combined with sequential organ failure assessment score

    摘要
  • 摘要:
    目的 通过连续监测肺部感染所致脓毒症患者发病早期血清炎性标志物的变化水平，并联合序贯器官衰竭评分（sequential organ failure assessment，SOFA）评估血清炎性标志物对患者预后的预测价值。
    方法 前瞻性收集2018年7月至2019年11月复旦大学附属中山医院收治的143例肺部感染所致脓毒症患者的临床信息和血液检测结果。根据入院28 d的临床结局将患者分为生存组（n=109）和死亡组（n=34）。连续性收集入组患者入院第1天、第3天的外周血白细胞计数（WBC）、淋巴细胞绝对值、高敏C-反应蛋白水平、降钙素原水平及细胞因子浓度，并计算入组患者的SOFA和急性生理和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluation Ⅱ，APACHEⅡ）评分。
    结果 死亡组入院时SOFA评分（P=0.003）、APACHEⅡ评分（P < 0.001）明显高于生存组，辅助通气（P < 0.001）和血管活性药物（P < 0.001）使用率高于生存组，入院后死亡组不同时间点血清白介素2受体（IL-2R）、IL-8、IL-10水平与生存组差异有统计学意义（P < 0.05）。多因素logistic回归分析发现，入院第1天的IL-2R浓度（OR=1.001，95% CI 1.000~1.001）、入院第3天的WBC（OR=1.246，95% CI 1.062~1.462）和IL-10（OR=1.188，95% CI 1.011~1.396）、入院3 d内的IL-6变化率（OR=2.488，95% CI 1.065~5.809）对患者临床预后有判断价值（P < 0.05）。SOFA联合IL-2R（第1天）、SOFA联合WBC和IL-10（第3天）、SOFA联合IL-6（3 d变化率）预测脓毒症患者入院28 d预后的受试者工作特征曲线下面积（AUC）分别为0.698（95% CI 0.601~0.795，P=0.001）、0.854（95% CI 0.789~0.919，P < 0.001）、0.795（95% CI 0.708~0.882，P < 0.001）。
    结论 对于肺部感染所致脓毒症患者，动态监测IL-2R、WBC、IL-6、IL-10有助于其入院28 d临床结局的判断；SOFA评分联合IL-2R（入院第1天）、WBC+IL-10（入院第3天）或IL-6（3 d变化率）可一定程度提高IL-2R、WBC、IL-6、IL-10对该类患者预后的预测价值。

     

    Abstract:
    Objective To explore the role of inflammatory biomarkers in patients with pneumonia induced sepsis by continuously detecting the levels of inflammatory biomarkers combined with sequential organ failure assessment (SOFA) score.
    Methods Blood samples and clinical information from 143 patients with pneumonia induced sepsis in Zhongshan University, Fudan University from July 2017 to November 2019 were enrolled. According to the clinical outcomes of 28 days after admission, patients were divided into survival group and dead group. The serum white blood cell count (WBC), absolute value of lymphocyte, and levels of high-sensitivity C-reactive protein, procalcitonin, and cytokines on the first and third day after admission were collected continuously, and the SOFA and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores of the included patients were calculated.
    Results The SOFA score (P=0.003) and APACHEⅡscore (P < 0.001) in the dead group were significantly higher than those in the survival group. The rates of patients using assisted ventilation (P < 0.001) and vasoactive drugs (P < 0.001) in the dead group were higher than those in the survival group. The differences of serum levels of interleukin (IL)-2R, IL-8, and IL-10 between the two groups had statistical significances at different time points after admission. Multivariate logistic regression analysis results showed that IL-2R on the first day after admission (OR=1.001, 95% CI 1.000-1.001), WBC (OR=1.246, 95% CI 1.062-1.462), and IL-10 (OR=1.188, 95% CI 1.011-1.396) the third day after admission, and the 3-day change rate of IL-6 (OR=2.488, 95% CI 1.065-5.809) were associated with the prognosis of patients(P < 0.05). The AUC of SOFA combined with IL-2R (day 1), SOFA combined with WBC and IL-10 (day 3), and SOFA combined with IL-6 (3-day change rate) for predicting 28-day prognosis of sepsis patients were 0.698 (95% CI 0.601-0.795, P=0.001), 0.854 (95% CI 0.789-0.919, P < 0.001), and 0.795 (95% CI 0.708-0.882, P < 0.001), respectively.
    Conclusions Dynamic monitoring of IL-2R, WBC, IL-6, and IL-10 can help to predict the clinical outcome of patients with pneumonia induced sepsis. SOFA score combined with IL-2R (day 1), WBC + IL-10 (day 3), and IL-6 (3-day change rate) can increase the value of serum markers for predicting prognosis of the patients to a certain extent.

     

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