血清sTREM-1、PCT水平和SOFA评分的组合可预测新生儿脓毒血症死亡率

The Combination of Serum, PCT Level and SOFA Score could Forecast Neonatal Sepsis Mortality

本研究基于急性生理学及慢性健康状况评分系统(acute physiology and chronic health evaluation system, APACHEⅡ)和序贯器官衰竭估计评分(sequential organ failure assessment, SOFA),探讨了可溶性髓系细胞触发受体-1 (soluble triggering receptor expresses on myeloid cells-1, s TREM-1)、降钙素原(procalcitonin,PCT)、N末端脑钠肽前体(N-terminal pro-brain natriuretic, NT-pro-BNP)、C-反应蛋白(C-reactive protein, CRP)等血清生物标志物和细胞因子对新生儿脓毒血症患儿预后的预测价值。本研究根据28 d死亡率将51例新生儿脓毒血症患儿分为存活组(n=30)和死亡组(n=21)。在入住重症加强护理病房(intensive care unit, ICU)后的第1天、第3天和第5天测量血清生物标志物和细胞因子的水平,同时计算急性生理学及慢性健康状况评分系统(APACHEⅡ)和序贯器官衰竭估计评分(SOFA)评分。结果显示:死亡组患儿血清可溶性髓系细胞触发受体-1 (sTREM-1)、降钙素原(PCT)和白细胞介素6 (interleukin 6, IL-6)水平显著高于存活组(p<0.01);预测28 d死亡率的受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)下面积显示,降钙素原(PCT)为0.779,可溶性髓系细胞触发受体-1 (sTREM-1)为0.843,序贯器官衰竭估计评分(SOFA)为0.951,急性生理学及慢性健康状况评分系统(APACHEⅡ)评分为0.917;多变量logistic回归分析显示,可溶性髓系细胞触发受体-1 (sTREM-1)、降钙素原(PCT)水平和序贯器官衰竭估计评分(SOFA)是28 d死亡率的独立预测因子;在存活组中,血清降钙素原(PCT)、可溶性髓系细胞触发受体-1 (sTREM-1)和白细胞介素6 (IL-6)水平显示随时间有降低的趋势(p<0.05),血清N末端脑钠肽前体(NT-pro-BNP)水平在第3天和第5天的显示出预测效用(p<0.05)。本研究结论初步表明,升高的血清可溶性髓系细胞触发受体-1 (sTREM-1)和降钙素原(PCT)水平具有更好的预后准确性。血清可溶性髓系细胞触发受体-1 (sTREM-1)、降钙素原(PCT)水平和序贯器官衰竭估计评分(SOFA)的组合可为新生儿脓毒血症死亡率提供较好的预测价值。

Based on acute physiology and chronic health evaluation system(APACHEⅡ)and sequential organ failure assessment(SOFA),this study evaluated prognostic values of serum biomarkers and cytokines such as soluble triggering receptor expresses on myeloid cells-1(s TREM-1),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-pro-BNP)and C-reactive protein(CRP)for newborns with sepsis.Based on the 28-day mortality rate,51 infants with neonatal sepsis were divided into the survival group(n=30)and the death group(n=21).The levels of serum biomarkers and cytokines were measured on the first,third and fifth days after ICU admission,and the scores of APACHE II and SOFA were calculated.The results showed that levels of s TREM-1,PCT and interleukin-6(IL-6)in the death group were significantly higher than those in the survival group(p<0.01).The area under the receiver operating characteristic curve(ROC curve)for predicting 28-day mortality was:0.779 for PCT,0.843 for s TREM-1,0.951 for SOFA,and 0.917 for APACHEⅡ.Multivariate logistic regression analysis showed that s TREM-1,PCT levels,and SOFA scores were independent predictors of the 28-day mortality rate.In the survival group,serum PCT,s TREM-1,and IL-6 levels showed a decreasing trend with time(p<0.05),and serum NT-pro-BNP levels showed predictive utility on the 3 rd and the 5 th day(p<0.05).These results preliminarily indicated that elevated serum s TREM-1 and PCT levels had better prognosis accuracy.The combination of serum s TREM-1,PCT levels and SOFA scores could provide better predictive values for neonatal sepsis mortality.