系统免疫炎症指数评估脓毒症严重程度和预后临床研究
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摘要
目的:探讨系统免疫炎症指数(systemic immune-inflammation index,SII)对脓毒症患者病情严重程度判断及预后评估的临床价值。方法:选择57名脓毒症患者为研究对象,患者按病情严重程度分为脓毒症组(30例)和脓毒性休克组(27例);根据28 d预后分为生存组(48例)和死亡组(9例)。记录患者入ICU时的SII、降钙素原(procalcitonin,PCT)、急性生理学与慢性健康状况评分系统Ⅱ评分(acute physiology and chronic health evaluationⅡscore,APACHEⅡ)及序贯器官衰竭评分(sequential organ failure assessment,SOFA)。比较脓毒症组、脓毒性休克组间SII、血PCT、APACHEⅡ及SOFA的差异。Spearman法分析各指标间的相关性。受试者工作特征(receiver operating characteristic,ROC)曲线分析SII、PCT、APACHEⅡ及SOFA对脓毒症患者预后评估的临床价值。结果:脓毒症组患者SII为[391.62(343.18,492.00)]×109/L,低于脓毒性休克组[1 454.17(689.96,2 467.52)]×109/L(P<0.05)。脓毒症组患者血PCT为[10.03(1.02,51.47)] ng/mL,脓毒性休克组[12.56(2.00,53.57)] ng/mL,两者没有统计学差异(P>0.05)。死亡组患者SⅡ、APACHEⅡ及SOFA均高于生存组(P<0.05);而血PCT水平在生存组和死亡组之间没有统计学差异(P>0.05)。Spearman相关分析分别分析SII与APACHⅡ、SOFA的相关性,SII与APACHⅡ进行相关性分析(r=0.628,P=0.001);脓毒症患者SII与SOFA进行相关性分析(r=0.638,P=0.001)。根据ROC曲线分析,SII的ROC曲线下面积(area under the ROC curve,AUC)为0.914(P<0.05),PCT的AUC为0.519(P>0.05),APACHEⅡ与SOFA的AUC均为0.868(P<0.05)。SII其截断值0.743。结论:SII有助于早期对脓毒症患者进行病情严重程度的判断和预后评估。
Objective:To investigate the clinical value of systemic immune-inflammation index(SII) in assessing disease severity and prognosis in patients with sepsis. Methods:A total of 57 patients with sepsis were enrolled as subjects. According to disease severity,these patients were divided into sepsis group with 30 patients and septic shock group with 27 patients;according to 28-day outcome,the patients were divided into survival group with 48 patients and death group with 9 patients. Related data were recorded at the time of admission to the intensive care unit, including SII, procalcitonin( PCT), Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score,and Sequential Organ Failure Assessment(SOFA) score. The sepsis group and the septic shock group were compared in terms of SII,blood PCT,APACHE Ⅱ,and SOFA. Spearman analysis was used to investigate the correlation between these indices. The receiver operating characteristic(ROC) curve was used to analyze the clinical value of SII,PCT,APACHE Ⅱ,and SOFA in evaluating the prognosis of patients with sepsis.Results :The sepsis group had a significantly lower SII than the septic shock group{[391.62(343.18,492.00)]×109/L vs. [1 454.17(689.96,2 467.52)]×109/L,P<0.05}. The sepsis group had a lower blood PCT level than the septic shock group {[10.03(1.02,51.47)] ng/mL vs. [12.56(2.00,53.57)] ng/mL,P >0.05}. The death group had significantly higher SII,APACHEⅡ score,and SOFA score than the survival group(P<0.05),while there was no significant difference in blood PCT level between the two groups(P>0.05). The Spearman correlation analysis showed that SII was positively correlated with APACHEⅡ score(r=0.628,P=0.001) and that SII was positively correlated with SOFA score in the patients with sepsis(r=0.638,P=0.001). The ROC curve analysis showed that SII had an area under the ROC curve(AUC) of 0.914(P<0.05),PCT had an AUC of 0.519(P>0.05),and APACHEⅡ and SOFA had an AUC of 0.868(P<0.05);SII had a cut-off value of 0.743.Conclusion:SII helps with early evaluation of disease severity and prognosis in patients with sepsis.
Objective:To investigate the clinical value of systemic immune-inflammation index(SII) in assessing disease severity and prognosis in patients with sepsis. Methods:A total of 57 patients with sepsis were enrolled as subjects. According to disease severity,these patients were divided into sepsis group with 30 patients and septic shock group with 27 patients;according to 28-day outcome,the patients were divided into survival group with 48 patients and death group with 9 patients. Related data were recorded at the time of admission to the intensive care unit, including SII, procalcitonin( PCT), Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score,and Sequential Organ Failure Assessment(SOFA) score. The sepsis group and the septic shock group were compared in terms of SII,blood PCT,APACHE Ⅱ,and SOFA. Spearman analysis was used to investigate the correlation between these indices. The receiver operating characteristic(ROC) curve was used to analyze the clinical value of SII,PCT,APACHE Ⅱ,and SOFA in evaluating the prognosis of patients with sepsis.Results :The sepsis group had a significantly lower SII than the septic shock group{[391.62(343.18,492.00)]×109/L vs. [1 454.17(689.96,2 467.52)]×109/L,P<0.05}. The sepsis group had a lower blood PCT level than the septic shock group {[10.03(1.02,51.47)] ng/mL vs. [12.56(2.00,53.57)] ng/mL,P >0.05}. The death group had significantly higher SII,APACHEⅡ score,and SOFA score than the survival group(P<0.05),while there was no significant difference in blood PCT level between the two groups(P>0.05). The Spearman correlation analysis showed that SII was positively correlated with APACHEⅡ score(r=0.628,P=0.001) and that SII was positively correlated with SOFA score in the patients with sepsis(r=0.638,P=0.001). The ROC curve analysis showed that SII had an area under the ROC curve(AUC) of 0.914(P<0.05),PCT had an AUC of 0.519(P>0.05),and APACHEⅡ and SOFA had an AUC of 0.868(P<0.05);SII had a cut-off value of 0.743.Conclusion:SII helps with early evaluation of disease severity and prognosis in patients with sepsis.
引文
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[25]李翠如,杨举红,张瑞萍,等. PCT在不同病理进程脓毒症诊断中的临床应用价值[J].实用检验医师杂志,2016,8(2):94-96,99.
[26]李贯清,刘宇,周荣斌.降钙素原在脓毒症诊断预后及抗感染中的应用[J].临床急诊杂志,2012,13(1):13-15.
[27] Boussekey N,Leroy O,Alfandari S,et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia[J]. Intensive Care Med,2006,32(3):469-472.
[28] Jensen JU,Heslet L,Jensen TH,et al. Procalcitonin increase in early identification of critically ill patients at high risk of mortality[J].Crit Care Med,2006,34(10):2596-2602.
[29] Level C,Chauveau P,Delmas Y,et al. Procalcitonin:a new marker of in ammation in haemodialysis patients?[J]. Nephrol Dial Transplant,2001,16(5):980-986.
[30] Meisner M,Schmidt J,Hüttner H,et al. The natural elimination rate of procalcitonin in patients with normal and impaired renal function[J]. Intensive Care Med,2000,26(S2):212-216.
[31] Salluh JI,Soares M,Coelho LM,et al. Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia:a cohort study[J]. J Crit Care,2011,26(2):193-200.
[32] Póvoa P,Souza-Dantas VC,Soares M,et al. C-reactive protein in critically ill cancer patients with sepsis:in uence of neutropenia[J]. Crit Care,2011,15(3):R129.
[2] Fleischmann C,Scherag A,Adhikari NK,et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations[J]. Am J Respir Crit Care Med,2016,193(3):259-272.
[3] Yang Z,Zhang J,Lu Y,et al. Aspartate aminotransferase-lymphocyte ratio index and systemic immune-inflammation index predict overall survival in HBV-related hepatocellular carcinoma patients after transcatheter arterial chemoembolization[J]. Oncotarget,2015,6(40):43090-43098.
[4] Liu X,Sun X,Liu J,et al. Preoperative C-reactive protein/albumin ratio predicts prognosis of patients after curative resection for gastric cancer[J]. Transl Oncol,2015,8(4):339-345.
[5] Hu B,Yang XR,Xu Y,et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma[J]. Clin Cancer Res,2014,20(23):6212-6222.
[6] Vincent JL,Sakr Y,Sprung CL,et al. Sepsis in European intensive care units:results of the SOAP study[J]. Crit Care Med,2006,34(2):344-353.
[7] Rivers EP,Ahrens T. Improving outcomes for severe sepsis and septic shock:tools for early identification of at-risk patients and treatment protocol implementation[J]. Crit Care Clin,2008,24(3S):1-47.
[8] Gupta R,Arora VK. Performance evaluation of APACHEⅡscore for an Indian patient with respiratory problems[J]. Indian J Med Res,2004,119(6):273-282.
[9] Vassar MJ,Lewis FR Jr,Chambers JA,et al. Prediction of outcome in intensive care unit trauma patients:a multicenter study of acute physiology and chronic health evaluation(APACHE),trauma and injury severity score(TRISS),and a 24-hour intensive care unit(ICU)point system[J]. J Trauma,1999,47(2):324-329.
[10] Ryan HM,Sharma S,Magee LA,et al. The usefulness of the APACHE II score in obstetric critical care:a structured review[J]. J Obstet Gynaecol Can,2016,38(10):909-918.
[11] Minne L,Abu-Hanna A,de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU:a systematic review[J]. Crit Care,2008,12(6):R161.
[12] Geng Y,Shao Y,Zhu D,et al. Systemic immune-inflammation index predicts prognosis of patients with esophageal squamous cell carcinoma:a propensity score-matched analysis[J]. Sci Rep,2016,6:39482.
[13] Yang Z,Zhang J,Lu Y,et al. Aspartate aminotransferase-lymphocyte ratio index and systemic immune-inflammation index predict overall survival in HBV-related hepatocellular carcinoma patients after transcatheter arterial chemoembolization[J]. Oncotarget,2015,6(40):43090-43098.
[14] Passardi A,Scarpi E,Cavanna L,et al. Inflammatory indexes as predictors of prognosis and bevacizumab efficacy in patients with metastatic colorectal cancer[J]. Oncotarget,2016,7(22):33210-3219.
[15] Rhodes A,Evans LE,Alhazzani W,et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J]. Intensive Care Med,2017,43(3):304-377.
[16] Sakka NE,Galley HF,Sharaki O,et al. Delayed neutrophil apoptosis in patients with multiple organ dysfunction syndrome[J]. Crit Care&Shock,2006,9(1):19-15.
[17] Li J,Li M,Su L,et al. Alterations of T helper lymphocyte subpopulations in sepsis,severe sepsis,and septic shock:a prospective observational study[J]. Inflammation,2015,38(3):995-1002.
[18] Wyllie DH,Bowler IC,Peto TE. Relation between lymphopenia and bacteraemia in UK adults with medical emergencies[J]. J Clin Pathol,2004,57(9):950-955.
[19] Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill[J].Bratisl Lek Listy,2001,102(1):5-14.
[20] Aydemir H,Piskin N,Akduman D,et al. Platelet and mean platelet volume kinetics in adult patients with sepsis[J]. Platelets,2015,26(4):331-335.
[21] Haesebaert J,Bénet T,Michallet M,et al. Septic shock during platelet transfusion in a patient with acute myeloid leukaemia[J]. BMJ Case Rep,2013,30:2013.
[22] Semple JW,Freedman J. Platelets and innate immunity[J]. Cell Mol Life Sci,2010,67(4):499-511.
[23]冯秀兰,古杰超.炎症指标在社区获得性肺炎诊断中的表达水平及其相关性分析[J].实用检验医师杂志,2016,8(3):146-148.
[24]保勇,史梦,喻华,等.检测血清降钙素原对感染性疾病及脓毒症的诊断价值[J].实用医院临床杂志,2012,9(1):94-96.
[25]李翠如,杨举红,张瑞萍,等. PCT在不同病理进程脓毒症诊断中的临床应用价值[J].实用检验医师杂志,2016,8(2):94-96,99.
[26]李贯清,刘宇,周荣斌.降钙素原在脓毒症诊断预后及抗感染中的应用[J].临床急诊杂志,2012,13(1):13-15.
[27] Boussekey N,Leroy O,Alfandari S,et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia[J]. Intensive Care Med,2006,32(3):469-472.
[28] Jensen JU,Heslet L,Jensen TH,et al. Procalcitonin increase in early identification of critically ill patients at high risk of mortality[J].Crit Care Med,2006,34(10):2596-2602.
[29] Level C,Chauveau P,Delmas Y,et al. Procalcitonin:a new marker of in ammation in haemodialysis patients?[J]. Nephrol Dial Transplant,2001,16(5):980-986.
[30] Meisner M,Schmidt J,Hüttner H,et al. The natural elimination rate of procalcitonin in patients with normal and impaired renal function[J]. Intensive Care Med,2000,26(S2):212-216.
[31] Salluh JI,Soares M,Coelho LM,et al. Impact of systemic corticosteroids on the clinical course and outcomes of patients with severe community-acquired pneumonia:a cohort study[J]. J Crit Care,2011,26(2):193-200.
[32] Póvoa P,Souza-Dantas VC,Soares M,et al. C-reactive protein in critically ill cancer patients with sepsis:in uence of neutropenia[J]. Crit Care,2011,15(3):R129.