血IL-6联合NGAL对老年脓毒症患者预后评估价值的研究

Study on the value of blood IL-6 combined with NGAL in predicting the prognosis of elderly patients with sepsis

目的探讨血白介素6(interleukin-6,IL-6)联合中性粒细胞明胶酶脂质运载蛋白(neutropil gelatinase-associated lipocalin,NGAL)对老年脓毒症患者临床预后的预测价值。方法选择2020年6月—2021年11月在复旦大学附属华东医院急诊科和老年综合病房住院的老年脓毒症患者,随访28 d,根据是否死亡分为存活组和死亡组。采用酶联免疫吸附法(ELISA)测定2组血IL-6、NGAL水平,并记录APACHEⅡ评分。应用受试者工作特征(ROC)曲线,评价血IL-6、NGAL水平对老年脓毒症患者预后的判断价值。结果纳入老年脓毒症患者72例,平均年龄(83.6±4.6)岁,死亡组较存活组而言,平均动脉压(MAP)更低,机械通气率更高,休克发生概率高,死亡组患者IL-6、NGAL均高于存活组,差异有统计学意义。2组间白细胞计数(WBC),C反应蛋白(CRP)、降钙素原(PCT)的差异均无统计学意义,Logistic回归分析显示,IL-6、NGAL、APACHEⅡ评分,是老年脓毒症患者死亡的独立危险因素。预测老年脓毒症患者死亡,IL-6的敏感度91.3%,特异度69.4%;NGAL的敏感度60.9%,特异度91.8%。IL-6与NGAL合并后曲线下面积0.930,高于二者单独应用时的AUC(0.848、0.788),合并后敏感度82.6%、特异度93.9%。结论血IL-6、NGAL是老年脓毒症患者死亡的独立危险因素,二者联合检测在评估老年脓毒症患者死亡时具有良好的预测价值。

Objective To investigate the value of serum interleukin-6(IL-6)combined with neutropil gelatinaseassociated lipocalin(NGAL)in predicting clinical prognosis of elderly patients with sepsis.Methods The elderly patients with sepsis who were hospitalized in the Department of Emergency and Geriatric General Ward of Huadong Hospital Affiliated to Fudan University from June 2020 to November 2021 were selected and followed up for 28 days.They were divided into survival group and death group according to whether they died or not.The levels of serum IL-6 and NGAL in the two groups were measured by enzyme-linked immunosorbent assay(ELISA),and APACHEⅡ score was recorded.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum IL-6 and NGAL in predicting the prognosis of elderly patients with sepsis.Results Seventy-two elderly patients with sepsis were included,with an average age of(83.6±4.6)years old.Compared with the survival group,the death group had lower mean arterial pressure(MAP),higher mechanical ventilation rate,and higher probability of shock.The levels of IL-6 and NGAL in the death group were higher than those in the survival group,and the difference was statistically significant.There were no statistically significant differences in white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)between the two groups.Logistic regression analysis showed that IL-6,NGAL and APACHEⅡ scores were independent risk factors for death in elderly patients with sepsis.When used to predict the death of elderly patients with sepsis,the sensitivity and specificity of IL-6 were 91.3%and69.4%;the sensitivity and specificity of NGAL were 60.9%and 91.8%,respectively.The area under the curve after the combination of IL-6 and NGAL was 0.930,which was significantly higher than the AUC when the two were used alone(0.848,0.788).The sensitivity and specificity after the combination were 82.6%and 93.9%,respectively.Conclusion Serum IL-6 and NGAL are independent risk factors for death in elderly patients with sepsis.The combined detection of IL-6 and NGAL has good value in predicting the death of elderly patients with sepsis.