IL-6及补体C1q联合SIC评分对脓毒症早期预警及预后的预测价值

The Role of IL-6 and Complement C1q Combined with SIC Score in the Diagnosis and Prognosis of Patients with Sepsis

摘要: 目的：探讨白细胞介素-6 (IL-6)、补体C1q与脓毒症相关凝血功能障碍(SIC)评分对脓毒症患者早期预警及预后的预测价值。方法：纳入青岛大学附属医院急诊以及重症监护室(ICU)收治的360名研究对象，收集患者的基线资料、实验室检查指标、SIC评分以及患者28 d的存活情况。采用单因素及多因素Logistic回归分析脓毒症早期预警及预后的独立危险因素。绘制受试者工作特征曲线(ROC曲线)评价IL-6、补体C1q及SIC评分单独及联合应用对脓毒症早期预警及预后的预测价值。结果：与非脓毒症组相比，脓毒症组IL-6、PCT、CRP以及SIC评分增高，C1q降低，差异具有统计学意义(P < 0.05)。脓毒症幸存组IL-6、C1q以及SIC评分与脓毒症死亡组间差异具有统计学意义(P < 0.05)。多因素Logistic回归分析显示，IL-6、C1q以及SIC评分是急诊住院以及重症监护室患者早期发生脓毒症的独立危险因素(P < 0.05)。IL-6、C1q以及SIC评分是脓毒症28 d死亡的独立危险因素(P < 0.05)。对于脓毒症患者的早期预警而言IL-6、C1q及SIC评分的AUC分别是0.769、0.743和0.831，其对应的截断值分别为112.41 pg/mL、139.3 mg/L和1.5分。对于脓毒症患者的预后而言IL-6、C1q及SIC评分的AUC分别是0.694、0.697和0.629，其对应的截断值分别为120.81 pg/mL、137.5 mg/L和3.5分。三者联合检测对脓毒症早期预警及预后的预测效能优于三者单独预测，AUC分别为0.877、0.772，P < 0.001。结论：IL-6、C1q以及SIC评分对脓毒症的早期预警及预后有一定预测价值，三者联合应用时预测效能最佳。

Abstract: Objective: To investigate the predictive value of interleukin-6 (IL-6), complement C1q and sepsis-associated coagulation dysfunction (SIC) score for early warning and prognosis in patients with sepsis. Methods: Three hundred and sixty study subjects admitted to the Emergency Department and Intensive Care Unit (ICU) of Qingdao University Hospital were enrolled, and baseline data, laboratory indicators, SIC scores, and patient survival within 28 d were collected. Independent risk factors for early warning and prognosis of sepsis were analyzed using univariate and multivariate logistic regression. The predictive value of IL-6, complement C1q, and SIC score alone and in combination for early warning and prognosis of sepsis was evaluated by plotting the subject’s work characteristic curve (ROC curve). Results: IL-6, PCT, CRP, and SIC scores were increased and C1q was decreased in the sepsis group compared to the non-sepsis group, and the difference was statistically significant (P < 0.05). The differences in IL-6, C1q, and SIC scores between the sepsis survivor group and the sepsis death group were statistically significant (P < 0.05). Multifactorial logistic regression analysis showed that IL-6, C1q, and SIC scores were independent risk factors for early onset of sepsis in patients hospitalized in the emergency as well as intensive care units (P < 0.05). IL-6, C1q, and SIC scores were independent risk factors for death from sepsis at 28 d (P < 0.05). For the diagnosis of sepsis patients the AUC of IL-6, C1q and SIC score were 0.769, 0.743 and 0.831, respectively, and their corresponding cut-off values were 112.41 pg/mL, 139.3 mg/L and 1.5 points, respectively. For the prognosis of sepsis patients the AUC of IL-6, C1q and SIC score were 0.694, 0.697 and 0.629, respectively, and their corresponding cut-off values were 120.81 pg/mL, 137.5 mg/L and 3.5 points, respectively. The predictive efficacy of the three combined tests for early warning and prognosis of sepsis was better than that of the three individually, with AUCs of 0.877 and 0.772, respectively, P < 0.001. Conclusion: IL-6, C1q, and SIC scores have predictive value for early warning and prognosis of sepsis, with the best predictive efficacy when all three are used in combination.