ICU脓毒症患者血清Presepsin、内毒素、IL-6、PCT水平与预后的相关性

Correlation between serum presepsin, endotoxin,IL-6,PCT levels and prognosis of ICU patients with sepsis

目的 分析重症监护病房(ICU)脓毒症患者血清可溶性白细胞分化抗原14亚型(Presepsin)、内毒素、白细胞介素(IL)-6、降钙素原(PCT)水平及其预后预测价值。方法 选取2018年1月—2020年1月海口市人民医院ICU收治的106例脓毒症患者为研究对象,根据病情分为脓毒症组44例、严重脓毒症组42例、脓毒症休克组20例,根据预后分为存活组88例和死亡组18例。对各组患者入ICU治疗24 h内的外周血白细胞计数(WBC)、血小板计数(PLT)及血清C-反应蛋白(CRP)、乳酸(LAC)、Presepsin、内毒素、IL-6、PCT水平进行比较。结果 随着病情加重,患者PLT水平逐渐降低,其他实验室指标水平逐渐升高(P<0.05)。患者PLT水平与病情严重程度呈负相关关系,其他实验室指标水平与病情严重程度呈正相关关系(P<0.05)。死亡组患者血清Presepsin、内毒素、IL-6、PCT水平均高于存活组,差异均有统计学意义(P<0.05)。血清Presepsin、内毒素、IL-6、PCT水平预测患者死亡的受试者工作特征曲线下面积均有统计学意义(P<0.05)。结论 ICU脓毒症患者病程早期的血清Presepsin、内毒素、IL-6、PCT水平均与其病情严重程度具有相关性,均可用于辅助预测患者的死亡风险,临床医生应酌情考虑采用这些新型标志物来提高临床评价效率。

OBJECTIVE To analyze the serum levels of soluble leukocyte differentiation antigen 14 subtype(sCD14-ST, presepsin), endotoxin, interleukin(IL)-6, procalcitonin(PCT), and their prognostic values in patients with sepsis in the intensive care unit(ICU). METHODS A total of 106 patients with sepsis admitted to ICU of Haikou People′s Hospital from Jan 2018 to Jan 2020 were selected as the research subjects. According to the severity of illness, they were divided into 44 cases of the sepsis group, 42 cases of the severe sepsis group, and 20 cases of the septic shock group. And according to the prognosis, they were further divided into 88 cases of the survival group and 18 case of the death group. The levels of white blood cell(WBC), platelet count(PLT) in the peripheral blood and the serum levels C-reactive protein(CRP), lactic acid(LAC), Presepsin, endotoxin, IL-6 and PCT were compared among each group within 24 hours after ICU treatment. RESULTS With the aggravation of the disease, the level of PLT in peripheral blood decreased gradually, and the level of other laboratory indexes increased significantly(P<0.05). The level of PLT was negatively correlated with the severity of disease, while the levels of other laboratory indexes were positive correlated with the severity of disease(P<0.05). The serum levels of presepsin, endotoxin, IL-6 and PCT of the patients in the death group were higher than those of the patients in the survival group and the differences were significant(P<0.05). The areas under receiver operating characteristic curve of the serum levels of presepsin, endotoxin and IL-6 in prediction of the death of patients with sepsis were statistically significant(P<0.05). CONCLUSION The serum levels of Presepsin, endotoxin, IL-6 and PCT in the early stage of the patients with sepsis in ICU were correlated with the severity of disease, which can be used to assist in predicting the risk of death. Clinicians should consider using these new markers to improve the efficiency of clinical evaluation.