Interleukin 27 as a sepsis diagnostic biomarker in critically ill adults.
Interleukin 27 as a sepsis diagnostic biomarker in critically ill adults.
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DOI：
10.1097/shk.0b013e3182a67632
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发表时间：
2013-11
期刊：
影响因子：
--
通讯作者：
Gibot S
中科院分区：
文献类型：
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作者：
Wong HR;Lindsell CJ;Lahni P;Hart KW;Gibot S
我们之前确定白细胞介素-27 （IL-27）是危重儿童败血症诊断的生物标志物。目前的研究测试了IL-27单独和联合PCT诊断危重成人败血症的性能。血清样本来自危重成人败血症生物标志物的前瞻性研究。初步分析采用受试者工作特征（ROC）曲线评价IL-27和PCT的表现，二次分析探讨IL-27在继发性肺源和非肺源感染脓毒症患者亚组中的表现。净再分类改善（NRI）用于估计与单独PCT相比IL-27的增量预测能力。使用分类回归树（CART）分析生成基于IL-27和pct的决策树。145例脓毒症，125例无脓毒症。IL-27的ROC曲线（曲线下面积[AUC]: 0.68; 95% CI: 0.62 ~ 0.75）低于PCT （AUC: 0.84; 95% CI: 0.79 ~ 0.89）。当比较有肺部感染源的患者和没有败血症的患者时，也观察到类似的结果。对于非肺源感染的脓毒症患者，在PCT中加入IL-27可改善鉴别（NRI = 0.685; p < 0.001）。cart衍生决策树的AUC为0.92 (95% CI: 0.88 - 0.96)，显著高于单独的PCT。当与PCT联合使用时，IL-27可以改善继发于非肺部感染源的重症成人脓毒症的分类。
We previously identified interleukin-27 (IL-27) as a sepsis diagnostic biomarker in critically ill children. The current study tested the performance of IL-27 alone and in combination with PCT for diagnosing sepsis in critically ill adults. Serum samples were made available from a prior prospective study of sepsis biomarkers in critically ill adults. The primary analysis used receiver operating characteristic (ROC) curves to evaluate the performance of IL-27 and PCT. Secondary analysis explored IL-27 performance in subgroups of patients with sepsis secondary to lung and non-lung sources of infection. The net reclassification improvement (NRI) was used to estimate the incremental predictive ability of IL-27 compared to PCT alone. Classification and Regression Tree (CART) analysis was used to generate an IL-27- and PCT-based decision tree. There were 145 patients with sepsis and 125 without sepsis. The ROC curve for IL-27 was inferior (area under the curve [AUC]: 0.68; 95% CI: 0.62 – 0.75) to that of PCT (AUC: 0.84; 95% CI: 0.79 – 0.89). Similar findings were observed when comparing patients with a lung source of infection and those without sepsis. For sepsis patients with a non-lung source of infection, adding IL-27 to PCT improved discrimination (NRI = 0.685; p < 0.001). The AUC for the CART-derived decision tree was 0.92 (95% CI: 0.88 – 0.96) and was significantly greater than that of PCT alone. When used in combination with PCT, IL-27 may improve classification of critically ill adults with sepsis secondary to a non-lung source of infection.