Profiling inflammatory markers in patients with pneumonia on intensive care.
Profiling inflammatory markers in patients with pneumonia on intensive care.
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DOI：
10.1038/s41598-018-32938-6
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发表时间：
2018-10-03
影响因子：
4.6
通讯作者：
Gordon AC
中科院分区：
文献类型：
--
作者：
Antcliffe DB;Wolfer AM;O'Dea KP;Takata M;Holmes E;Gordon AC
临床调查在诊断肺炎时缺乏预测价值，特别是当患者进行通气并发展为呼吸机相关性肺炎（VAP）时。辅助诊断的新工具对改善预后非常重要。这项初步研究检查了一组炎症介质的潜力，以帮助诊断。纳入44例通气患者，其中17例为肺炎，27例为脑损伤，其中8例为VAP。采用流式细胞术和质谱法测定患者血清中的51种炎症介质，包括细胞因子和氧化脂素。介质可将ICU住院的肺炎患者与脑损伤患者分开，受试者工作特征曲线下面积（AUROC）为0.75（0.61-0.90）。两组患者在ICU期间炎症介质的变化相似，5,6-二羟基二碳三烯酸和8,9-二羟基二碳三烯酸随时间增加，白细胞介素-6减少。然而，发生VAP的脑损伤患者的炎症特征与入院时相似。一个包含5,6-二羟基二碳三烯酸、8,9-二羟基二碳三烯酸、细胞间粘附分子-1、白细胞介素-6和白细胞介素-8的多变量模型可以区分VAP患者和未感染的脑损伤患者（AUROC为0.94(0.80-1.00)）。选定的一组标记物的使用显示出帮助VAP诊断的希望，特别是当与临床数据相结合时。
Clinical investigations lack predictive value when diagnosing pneumonia, especially when patients are ventilated and develop ventilator associated pneumonia (VAP). New tools to aid diagnosis are important to improve outcomes. This pilot study examines the potential for a panel of inflammatory mediators to aid in the diagnosis. Forty-four ventilated patients, 17 with pneumonia and 27 with brain injuries, eight of whom developed VAP, were recruited. 51 inflammatory mediators, including cytokines and oxylipins, were measured in patients’ serum using flow cytometry and mass spectrometry. The mediators could separate patients admitted to ICU with pneumonia compared to brain injury with an area under the receiver operating characteristic curve (AUROC) 0.75 (0.61–0.90). Changes in inflammatory mediators were similar in both groups over the course of ICU stay with 5,6-dihydroxyeicosatrienoic and 8,9-dihydroxyeicosatrienoic acids increasing over time and interleukin-6 decreasing. However, brain injured patients who developed VAP maintained inflammatory profiles similar to those at admission. A multivariate model containing 5,6-dihydroxyeicosatrienoic acid, 8,9-dihydroxyeicosatrienoic acid, intercellular adhesion molecule-1, interleukin-6, and interleukin-8, could differentiate patients with VAP from brain injured patients without infection (AUROC 0.94 (0.80–1.00)). The use of a selected group of markers showed promise to aid the diagnosis of VAP especially when combined with clinical data.
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