Interleukin-6 significantly improves predictive value of systemic inflammatory response syndrome for predicting severe acute pancreatitis
Interleukin-6 significantly improves predictive value of systemic inflammatory response syndrome for predicting severe acute pancreatitis
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DOI：
10.1016/j.pan.2018.05.002
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发表时间：
2018-07-01
期刊：
影响因子：
3.6
通讯作者：
Garg, Pramod Kumar
中科院分区：
文献类型：
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作者：
Jain, Saransh;Midha, Shallu;Garg, Pramod Kumar
背景：预测严重急性胰腺炎（AP）对于分诊、预后和设计治疗试验非常重要。持续性全身炎症反应综合征（SIRS）预测严重AP，但其诊断准确性不理想。我们的目的是研究细胞因子水平是否可以提高严重AP发展的临床变量的预测价值。方法：在三级保健中心的前瞻性队列研究中纳入连续的AP患者。在AP发病第3天测定血清IL-6、tnf - α、IL-10、MCP-1、GM-CSF和IL-1 β水平。通过多变量回归分析，对年龄、合共发病、病因、SIRS和细胞因子等变量进行建模，以预测严重AP。通过基因分型分析IL-6、tnf - α和MCP-1基因多态性与细胞因子水平的相关性。结果：236例AP患者中，发病7天内入院的115例患者组成研究组。115例患者中有37例（32%）发生器官衰竭。器官衰竭的独立预测因子是持续性SIRS （OR 34; 95% CI: 7.2-159）和第3天血清IL-6为bb0 160 pg/ml （OR 16.1; 95% CI:1.8-142）。IL-6基因（-174 G/C） GG基因型与CC/CG基因型相比，IL-6水平显著升高。血清IL-6 > 160pg /ml在不影响敏感性和阴性预测值的情况下，将持续性SIRS的阳性预测值从56%提高到85%，特异性从64%提高到95%。结论：血清IL-6浓度> 160 ng/ml显著提高SIRS对重症AP (C) 2018 IAP和EPC的预测价值。Elsevier B.V.版权所有。
Background: Predicting severe acute pancreatitis (AP) is important for triage, prognosis, and designing therapeutic trials. Persistent systemic inflammatory response syndrome (SIRS) predicts severe AP but its diagnostic accuracy is suboptimal. Our objective was to study if cytokine levels could improve the predictive value of clinical variables for the development of severe AP.Methods: Consecutive patients with AP were included in a prospective cohort study at a tertiary care center. Serum levels of IL-6, TNF-alpha, IL-10, MCP-1, GM-CSF and IL-1 beta were measured at day 3 of onset of AP. Variables such as age, co-morbidity, etiology, SIRS, and cytokines were modeled to predict severe AP by multivariable regression analysis. Genotyping was done to correlate IL-6, TNF-alpha and MCP-1 gene polymorphisms with cytokine levels.Results: Of 236 patients with AP, 115 patients admitted within 7 days of onset formed the study group. 37 of the 115 (32%) patients developed organ failure. Independent predictors of organ failure were persistent SIRS (OR 34; 95% CI: 7.2-159) and day 3 serum IL-6 of > 160 pg/ml (OR 16.1; 95% CI:1.8-142). IL-6 gene (-174 G/C) GG genotype was associated with significantly higher levels of IL-6 compared to CC/CG genotype. Serum IL-6 > 160 pg/ml increased the positive predictive value of persistent SIRS from 56% to 85% and specificity from 64% to 95% for predicting OF without compromising its sensitivity and negative predictive value.Conclusion: Serum IL-6 of > 160 ng/ml added significantly to the predictive value of SIRS for severe AP. (C) 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.