Immune Profiling To Predict Outcome of Clostridioides difficile Infection
Immune Profiling To Predict Outcome of Clostridioides difficile Infection
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DOI：
10.1128/mbio.00905-20
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发表时间：
2020-05-01
期刊：
影响因子：
6.4
通讯作者：
Petri, William A. Jr Jr
中科院分区：
文献类型：
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作者：
Abhyankar, Mayuresh M.;Ma, Jennie Z.;Petri, William A. Jr Jr
迫切需要基于生物标志物的模型来预测艰难梭菌感染（CDI）的死亡率和复发率。风险分层将使有针对性的干预措施，如粪便微生物群移植，抗毒素抗体和结肠切除术，为那些在最高风险。由于CDI的严重程度与免疫反应有关，我们在诊断时对患者进行免疫分析。对341例CDI患者进行了17种细胞因子的检测。关注的主要结局是90天死亡率。通过单变量分析，肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、C-C基序趋化因子配体5（CCL-5）升高、致瘤性2受体（sST-2）、IL-8和IL-15抑制可预测死亡率。在调整人口统计学和临床特征后，TNF-α和IL-8前25百分位数患者的死亡风险（如危险比[HR]所示）较高（HR = 8.35，P = 0.005），而CCL-5较低（HR = 0.18，P = 0.01）。
There is a pressing need for biomarker-based models to predict mortality from and recurrence of Clostridioides difficile infection (CDI). Risk stratification would enable targeted interventions such as fecal microbiota transplant, antitoxin antibodies, and colectomy for those at highest risk. Because severity of CDI is associated with the immune response, we immune profiled patients at the time of diagnosis. The levels of 17 cytokines in plasma were measured in 341 CDI inpatients. The primary outcome of interest was 90-day mortality. Increased tumor necrosis factor alpha (TNF-alpha), interleukin 6 (IL-6), C-C motif chemokine ligand 5 (CCL-5), suppression of tumorigenicity 2 receptor (sST-2), IL-8, and IL-15 predicted mortality by univariate analysis. After adjusting for demographics and clinical characteristics, the mortality risk (as indicated by the hazard ratio [HR]) was higher for patients in the top 25th percentile for TNF-or (HR = 8.35, P = 0.005) and IL-8 (HR = 4.45, P = 0.01) and lower for CCL-5 (HR = 0.18, P