降钙素原和白细胞介素-6与抗凝血酶Ⅲ联合检测对脓毒症患者病情严重程度及预后的预测价值

Predictive effect of combined procalcitonin,interleukin-6 and antithrombinⅢon the severity and prognosis of patients with sepsis

目的:探讨降钙素原(PCT)、白细胞介素?-?6(IL-6)和抗凝血酶Ⅲ(ATⅢ)与脓毒症患者病情严重程度的相关性,以及上述指标单独或联合检测对脓毒症患者预后的预测价值。方法:采用回顾性队列研究方法,选择2021年4月至2022年9月山东第一医科大学附属省立医院东院重症医学科收治的85例脓毒症患者。收集患者的一般资料、入科24 h内序贯器官衰竭评分(SOFA)和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、入科时炎症指标〔PCT、IL-6、血清淀粉样蛋白A(SAA)、中性粒细胞与淋巴细胞比值(NLR)、C?-?反应蛋白(CRP)〕和凝血指标(D?-?二聚体、ATⅢ)水平,以及28 d预后。比较不同28 d预后及不同严重程度脓毒症患者上述指标的差异;采用Spearman等级相关法分析脓毒症患者PCT、IL-6及ATⅢ与病情严重程度的相关性;绘制受试者工作特征曲线(ROC曲线),评价PCT、IL-6及ATⅢ 3个指标单独或联合检测对脓毒症患者28 d死亡的预测价值。结果:85例患者均纳入最终分析,28 d存活67例,死亡18例,28 d病死率为21.2%。两组患者性别、年龄等一般资料差异无统计学意义;死亡组患者病情较存活组更重,且PCT、IL-6、CRP水平均明显高于存活组〔PCT(μg/L):4.34(1.99,14.42)比1.17(0.31,3.94),IL-6(ng/L):332.40(50.08,590.18)比61.95(31.64,194.20),CRP(mg/L):149.28(75.34,218.60)比83.23(48.22,174.96),均 P<0.05〕,ATⅢ活性明显低于存活组〔(53.67±28.57)%比(80.96±24.18)%, P<0.01〕;但两组D?-?二聚体、NLR及SAA差异均无统计学意义。85例患者中,脓毒症伴单器官功能障碍36例,脓毒症伴多器官功能障碍29例,脓毒性休克伴多器官功能障碍20例;随着病情严重程度的增加,脓毒症患者PCT、IL-6水平逐渐升高〔PCT(μg/L):0.36(0.19,1.10)、3.00(1.22,9.94)、4.34(2.18,8.86),IL-6(ng/L):43.99(20.73,111.13)、100.00(45.37,273.00)、332.40(124.40,693.65)〕,ATⅢ活性逐渐下降〔(89.81±21.42)%、(71.97±24.88)%、(53.50±25.41)%〕,各组间比较差异均有统计学意义(均 P<0.01)。Spearman等级相关分析显示,脓毒症患者PCT、IL-6水平与病情严重程度呈显著正相关( r值分别为0.562、0.517,均 P<0.01),ATⅢ活性与病情严重程度呈显著负相关( r=-0.523, P<0.01)。ROC曲线分析显示,PCT、IL-6及ATⅢ单独或联合检测对脓毒症患者28 d死亡均有一定预测价值,上述3项指标联合检测的ROC曲线下面积(AUC)大于单独检测(0.818比0.722、0.725、0.770),敏感度为83.3%,特异度为73.1%。 结论:脓毒症患者PCT、IL-6和ATⅢ与病情严重程度显著相关;上述3项指标联合检测能够有效提高对脓毒症患者预后的预测效果。

ObjectiveTo investigate the correlation of procalcitonin(PCT),interleukin-6(IL-6)and antithrombinⅢ(ATⅢ)with the severity of sepsis,and to compare the predictive value of the above indicators alone or in combination.MethodsA retrospective cohort study was conducted.Eighty-five patients with sepsis admitted to the department of intensive care medicine of Shandong Provincial Hospital Affiliated to Shandong First Medical University from April 2021 to September 2022 were enrolled.General information,sequential organ failure assessment(SOFA)score and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hours of admission,inflammatory indicators[PCT,IL-6,serum amyloid A(SAA),neutrophil to lymphocyte ratio(NLR),and C-reactive protein(CRP)]and coagulation indicators(D-dimer and ATⅢ)levels at admission,and 28-day prognosis were collected.The differences of the above indicators were compared among patients with different prognosis at 28 days and different severity of sepsis.The correlation between PCT,IL-6,ATⅢand the severity of sepsis was analyzed by Spearman rank correlation method.Receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of PCT,IL-6 and ATⅢalone or in combination on the 28-day death of patients with sepsis.ResultsEighty-five patients were enrolled finally,67 cases survived and 18 cases died at 28 days.The mortality was 21.2%.There were no statistical significant differences in gender,age and other general data between the two groups.The patients in the death group were more serious than those in the survival group,and PCT,IL-6,and CRP levels were significantly higher than those in the survival group[PCT(μg/L):4.34(1.99,14.42)vs.1.17(0.31,3.94),IL-6(ng/L):332.40(50.08,590.18)vs.61.95(31.64,194.20),CRP(mg/L):149.28(75.34,218.60)vs.83.23(48.22,174.96),all P<0.05],and ATⅢactivity was significantly lower than that in the survival group[(53.67±28.57)%vs.(80.96±24.18)%,P<0.01].However,there were no significant differences in D-dimer,NLR and SAA between the two groups.Among the 85 patients,36 had sepsis with single organ dysfunction,29 had sepsis with multiple organ dysfunction,and 20 had septic shock with multiple organ dysfunction.With the increase of the severity of sepsis,PCT and IL-6 levels gradually increased[PCT(μg/L):0.36(0.19,1.10),3.00(1.22,9.94),4.34(2.18,8.86);IL-6(ng/L):43.99(20.73,111.13),100.00(45.37,273.00),332.40(124.4,693.65)],and the activity of ATⅢdecreased gradually[(89.81±21.42)%,(71.97±24.88)%,and(53.50±25.41)%],all with statistically significant differences(all P<0.01).Spearman rank correlation analysis showed that PCT and IL-6 levels in sepsis patients were significantly positively correlated with the severity of the disease(r values were 0.562 and 0.517,respectively,both P<0.01),and ATⅢactivity was significantly negatively correlated with the severity of the disease(r=-0.523,P<0.01).ROC curve analysis showed that PCT,IL-6,and ATⅢalone or in combination had some predictive value for the death of sepsis patients at 28 days.The area under the ROC curve(AUC)of the above three indicators in combination was higher than that of the individual tests(0.818 vs.0.722,0.725,and 0.770),with a sensitivity of 83.3%and a specificity of 73.1%.ConclusionsPCT,IL-6,and ATⅢwere significantly correlated with the severity of sepsis patients.The combined assay of the above three indicators can effectively improve the prediction of the prognosis of sepsis patients.