Predictive value of monocyte histocompatibility leukocyte antigen-DR expression and plasma interleukin-4 and-10 levels in critically ill patients with sepsis
Predictive value of monocyte histocompatibility leukocyte antigen-DR expression and plasma interleukin-4 and-10 levels in critically ill patients with sepsis
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DOI：
10.1097/01.shk.0000068322.08268.b4
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发表时间：
2003-07-01
期刊：
影响因子：
3.1
通讯作者：
Valtonen, M
中科院分区：
文献类型：
--
作者：
Hynninen, M;Pettilä, V;Valtonen, M
有人提出，脓毒症中抗炎通路的过度激活可能导致脓毒症患者预后不良。本研究的目的是测试血液单核细胞上组织相容性白细胞抗原 (HLA)-DR 表达以及白细胞介素 (IL)-4 和 -10 血浆水平在预测脓毒症患者医院死亡率中的价值。两家大学医院重症监护病房的 61 名脓毒症重症患者前瞻性地参加了这项研究。幸存者 (n = 41) 和非幸存者 (n = 20) 入院时 HLA-DR 表达存在显着差异：幸存者的中位数为 84%（四分位数范围 64%-98%），而非幸存者的中位数为 62%（四分位数范围 47%-83%，Mann-Whitney 检验 P = 0.025）。同样，分析显示幸存者和非幸存者在入院血浆 IL-10 水平以及入院序贯器官衰竭评估 (SOFA) 和急性生理学和慢性健康评估 (APACHE) II 评分方面存在统计学显着差异，但在 IL-4 水平上没有显着差异。受试者工作曲线下面积（AUC）显示，单核细胞 HLA-DR 表达和血浆 IL-4 水平在预测医院死亡率方面的判别能力较差（AUC < 0.70）。只有第 1 天和第 2 天的 IL-10 水平显示出合理的预测能力（AUC 分别为 0.706 和 0.725）。 AUC 值最高的是 APACHE-II (0.786) 和入院 SOFA 评分 (0.763)。总之，入院时的 APACHE II 和 SOFA 评分在预测脓毒症危重患者的医院死亡率方面比 HLA-DR 表达以及 IL-10 和 IL-4 水平显示出更好的区分力。
It has been suggested that excessive activation of the anti-inflammatory pathways in sepsis may lead to poor outcome of patients with sepsis. The aim of this study was to test the value of histocompatibility leukocyte antigen (HLA)-DR-expression on blood monocytes and plasma levels of interleukin (IL)-4 and -10 in prediction of hospital mortality in patients with sepsis. Sixty-one critically ill patients with sepsis were prospectively enrolled to this study in two university hospital intensive care units. Survivors (n = 41) and nonsurvivors (n = 20) differed significantly in HLA-DR expression at admission: survivors' median 84% (interquartile range 64%-98%) versus nonsurvivors' median 62% (interquartile range 47%-83%, P = 0.025 by Mann-Whitney test). Similarly, the analysis revealed statistically significant differences between survivors and nonsurvivors in admission plasma IL-10 levels and in admission Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores, but not in IL-4 levels. The areas under receiver operating curves (AUC) showed that both monocyte HLA-DR expression and plasma IL-4 level showed poor discriminative power in prediction of hospital mortality (AUC < 0.70). Only IL-10 levels on days 1 and 2 showed reasonable predictive power (AUCs 0.706 and 0.725, respectively). The highest AUC values were those of APACHE-II (0.786) and admission SOFA score (0.763). In conclusion, APACHE II and SOFA scores on admission showed better discriminatory power than HLA-DR expression and IL-10 and IL-4 levels in prediction of hospital mortality in critically ill patients with sepsis.