Endotoxin, cytokines, and procalcitonin in febrile patients admitted to the hospital:: Identification of subjects at high risk of mortality
Endotoxin, cytokines, and procalcitonin in febrile patients admitted to the hospital:: Identification of subjects at high risk of mortality
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DOI：
10.1086/317480
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发表时间：
2000-12-01
影响因子：
11.8
通讯作者：
van Dissel, JT
中科院分区：
文献类型：
--
作者：
van Langevelde, P;Joop, K;van Dissel, JT
我们前瞻性检查了464例发热患者（中位年龄61岁）的院内死亡预测因子，采用单因素和多因素logistic回归，结合临床数据（年龄、潜在疾病、发热持续时间、寒颤和入院时休克）和血浆内毒素、tnf - α、IL-6、IL-10和降钙素原水平。31例入院时发生休克的患者死亡率高出4.6倍（95%可信区间[CI]， 1.8-12），其中7例死亡；与死亡率相关性最强的是内毒素浓度（相对危险度，13.7;95% CI, 1.4-136），预测了5例死亡，假阳性率为5%。433例入院时无休克的患者中，死亡率（26例死亡）与年龄和潜在疾病相关：临床数据预测了30%的死亡，而IL-6和降钙素原水平确定了额外的10%，假阳性率为5%。当发热患者在入院时进行筛查，以确定那些具有高死亡率的患者时，基于年龄、潜在疾病和近期病史的临床判断比内毒素、细胞因子和降钙素原水平的预测价值更重要。只有在出现休克的患者中，内毒素水平的测量才能帮助预测那些可能会死亡的患者，其代价是产生很少的假阳性结果。
We prospectively examined 464 febrile patients (median age, 61 years) for predictors of in-hospital death, by use of univariate and multivariate logistic regression using clinical data (age, underlying disease, duration of fever, chills, and shock on admission) and plasma endotoxin, TNF-alpha, IL-6, IL-10, and procalcitonin levels. The mortality rate was 4.6-fold higher (95% confidence interval [CI], 1.8-12) in 31 patients with shock on admission, 7 of whom died; the strongest association with mortality was the endotoxin concentration (relative risk, 13.7; 95% CI, 1.4-136), which predicted 5 of the deaths with a 5% false-positive rate. For 433 patients without shock on admission, mortality (26 deaths) was associated with age and underlying disease: clinical data predicted 30% of the deaths, whereas IL-6 and procalcitonin levels identified an extra 10% with a 5% false- positive rate. When febrile patients are screened on hospital admission to identify those with a high risk for mortality, clinical judgment on the basis of age, underlying disease, and recent history outweighs the predictive value of endotoxin, cytokine, and procalcitonin levels. Only in patients who present with shock will measurement of endotoxin levels help predict those who will likely die at the cost of few false- positive results.