A combined score of pro- and anti-inflammatory interleukins improves mortality prediction in severe sepsis
A combined score of pro- and anti-inflammatory interleukins improves mortality prediction in severe sepsis
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DOI：
10.1016/j.cyto.2011.12.002
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发表时间：
2012-03-01
期刊：
影响因子：
3.8
通讯作者：
Bermejo-Martin, Jesus F.
中科院分区：
文献类型：
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作者：
Andaluz-Ojeda, David;Bobillo, Felipe;Bermejo-Martin, Jesus F.
识别死亡风险增加的患者在严重脓毒症中非常重要。细胞因子已被广泛评估为这种疾病的潜在生物标志物，但研究的细胞因子均未证明具有足够的特异性或敏感性，可常规用于临床实践。在这项初步研究中，我们使用Bio-Rad人类细胞因子17-panel（Bio-Rad）分析了29例连续招募的严重脓毒症或脓毒性休克患者在进入ICU后的前24小时内血浆中的17种免疫介质。平均年龄66.1岁。我们的队列中有12例患者在ICU住院期间死亡，其中8例在最初的72小时内死于多器官功能障碍综合征（MODS）。血浆中三种促炎介质（IL-6、IL-8、MCP-1）和一种免疫抑制介质（IL-10）的水平在具有致死性结局的患者中更高。基于考克斯回归分析的结果，我们开发了一种具有这些细胞因子的组合评分，其显示出在我们的队列中更好地预测死亡率。这样，IL-6、IL-8和IL-10被包括在评分中。根据这三种白细胞介素血浆水平的第75百分位数（P75）将患者分为两组。显示至少一个白细胞介素值高于P75的那些患者被赋予值“1”。显示IL-6、IL-8、IL-10水平低于P75的那些患者被赋予值“0”。第3天和第28天死亡率的风险比与综合评分相比，高出2-3倍。总之，我们已经描述了与脓毒症患者预后较差相关的联合细胞因子评分，这可能代表了一种新的途径，可用于指导这种疾病的治疗决策。(C)2011爱思唯尔有限公司保留所有权利。
Identification of patients at increased risk of death is dramatically important in severe sepsis. Cytokines have been widely assessed as potential biomarkers in this disease, but none of the cytokines studied has evidenced a sufficient specificity or sensitivity to be routinely employed in clinical practice. In this pilot study, we profiled 17 immune mediators in the plasma of 29 consecutively recruited patients with severe sepsis or septic shock, during the first 24 h following admission to the ICU, by using a Bio-Plex Human Cytokine 17-Plex Panel (Bio-Rad). Patients were 66.1 year old in average. Twelve patients of our cohort died during hospitalization at the ICU, eight of them in the first 72 h due to multiorganic dysfunction syndrom (MODS). Levels in plasma of three pro-inflammatory mediators (IL-6, IL-8, MCP-1) and of an immunosuppressive one (IL-10) were higher in those patients with fatal outcome. We developed a combined score with those cytokines showing to better predict mortality in our cohort based on the results of Cox regression analysis. This way, IL-6, IL-8 and IL-10 were included in the score. Patients were split into two groups based on the percentile 75 (P75) of the plasma levels of these three interleukins. Those patients showing at least one interleukin value higher than P75 were given the value "1". Those patients showing IL-6, IL-8, IL-10 levels below P75 were given the value "0". Hazard ratios for mortality at day 3 and day 28th obtained with the combined score were 2-3-fold higher than those obtained with the individual interleukins values. In conclusion, we have described a combined cytokine score associated with a worse outcome in patients with sepsis, which may represent a new avenue to be explored for guiding treatment decisions in this disease. (C) 2011 Elsevier Ltd. All rights reserved.