IL-10/Lym联合序贯器官衰竭估计评分对脓毒性休克患者28 d死亡风险的预测价值

肖泽让; 何书典; 邢柏

doi:10.13201/j.issn.1009-5918.2022.02.001

IL-10/Lym联合序贯器官衰竭估计评分对脓毒性休克患者28 d死亡风险的预测价值

- 海南医学院第二附属医院急诊科(海口，570311)
基金项目:
海南省自然科学资金资助项目(No：819MS128)

详细信息

通讯作者: 邢柏，E-mail：xb36370887@163.com

中图分类号: R631

收稿日期: 2021-11-12

刊出日期: 2022-02-10

Predictive value of interleukin-10 to lymphocyte ratio combined with sequential organ failure assessment score for 28-day mortality risk in patients with septic shock

- Department of Emergency, the Second Affiliated Hospital of Hainan Medical University, Haikou, 570311, China

More Information

Corresponding author: XING Bai, E-mail: xb36370887@163.com

Received Date: 12 November 2021

Publish Date: 10 February 2022

摘要

摘要: 目的探讨白细胞介素-10与淋巴细胞比值(IL-10/Lym)联合序贯器官衰竭估计(SOFA)评分对脓毒性休克患者28 d死亡风险的预测价值，以期为临床医生对脓毒性休克患者不良预后的早期评估提供帮助。方法纳入2020年1月—2021年9月期间海南医学院第二附属医院急诊重症监护室(EICU)收治的脓毒性休克患者105例，收集患者的临床资料及检测IL-10和Lym水平，并计算IL-10/Lym值。根据28 d预后情况，将患者分为死亡组(27例)和存活组(78例)。比较两组患者的临床资料以及IL-10、Lym和IL-10/Lym水平。采用多因素Cox比例风险回归模型探究脓毒性休克患者28 d死亡的影响因素。通过受试者工作特征曲线(ROC)评价各指标在预测脓毒性休克患者28 d死亡风险中的应用价值。结果脓毒性休克患者在本研究中的28 d病死率为25.7%(27/105)。死亡组患者年龄、SOFA评分、急性生理学与慢性健康状况Ⅱ(APACHE Ⅱ)评分、IL-10、IL-10/Lym和血乳酸(Lac)与存活组相比明显升高，差异具有统计学意义(P< 0.05)。Kalpan-Meier分析显示，低IL-10/Lym组比高IL-10/Lym组具有较高的生存优势(χ²=14.491，P< 0.001)。多因素Cox比例风险回归模型分析结果显示，年龄>65岁(HR=3.599，95%CI：1.373~9.434，P=0.009)、IL-10/Lym(HR=1.041，95%CI：1.014~1.070，P=0.003)和SOFA评分(HR=1.474，95%CI：1.201~1.808，P< 0.001)是脓毒性休克患者28 d死亡独立影响因素。ROC曲线分析结果显示，IL-10/Lym联合SOFA评分预测脓毒性休克患者28 d死亡风险的AUC明显高于两个指标单独预测(0.931 vs.0.869，Z=2.129，P< 0.05；0.931 vs.0.850，Z=2.604，P< 0.05)。当IL-10/Lym最佳截断值为27.5 ng·10^-9时，其诊断敏感度为74.13%，特异度为93.62%；当SOFA评分最佳截断值为10分时，其诊断敏感度为70.41%，特异度为87.24%。结论 IL-10/Lym和SOFA评分值升高是脓毒性休克患者28 d死亡的独立危险因素，两者联合检测在预测脓毒性休克患者的28 d死亡风险方面具有较好的临床价值。
- 白细胞介素-10与淋巴细胞比值 /
- 序贯器官衰竭估计评分 /
- 脓毒性休克 /
- 预测价值 /
- 病死率
Abstract: Objective To investigate the predictive value of interleukin-10 to lymphocyte ratio(IL-10/Lym) combined with sequential organ failure assessment(SOFA) score for 28-day mortality risk in patients with septic shock, to provide help for clinical physicians to make the early assessment of poor prognosis of patients with septic shock.Methods One hundred and five patients with septic shock treated in the emergency intensive care unit(EICU) of the Second Affiliated Hospital of Hainan Medical College from January 2020 to September 2021 were enrolled. The clinical data of the patients were collected, the levels of IL-10 and Lym were detected, and the IL-10/Lym values were calculated. The patients were divided into the death group(n=27) and the survival group(n=78), according to the 28-day prognosis. The clinical data and the levels of IL-10, Lym and IL-10/Lym were compared between the two groups. Multivariate Cox proportional hazards regression model was performed to explore the influencing factors of 28-day mortality in patients with septic shock. Receiver operating characteristic curve(ROC) was applied to evaluate the application value of various indicators for predicting 28-day mortality risk in patients with septic shock.Results The 28-day mortalityof patients with septic shock in this study was 25.7%(27/105). The age, SOFA score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, IL-10, IL-10/Lym and serum lactic acid(Lac) in the death group were significantly higher than those in the survival group, and the differences were statistically significant(P< 0.05). Kalpan-Meier analysis showed that the low IL-10/Lym group had a higher survival advantage than the high IL-10/Lym group(χ²=14.491,P< 0.001). Multivariate Cox proportional hazards regression model analysis showed that age over 65 years(HR=3.599, 95%CI: 1.373-9.434,P=0.009), IL-10/Lym(HR=1.041, 95%CI: 1.014-1.070,P=0.003) and SOFA score(HR=1.474, 95%CI: 1.201-1.808,P< 0.001) were independent influencing factors for 28-day mortality in patients with septic shock. ROC curve analysis showed that the area under the curve(AUC) of IL-10/Lym combined with SOFA score for predicting 28-day mortality risk in patients with septic shock was significantly larger than that of IL-10/Lym or SOFA score alonely(0.931 vs. 0.869,Z=2.129,P< 0.05; 0.931 vs. 0.850,Z=2.604,P< 0.05). The optimal cut-off value of IL-10/Lym was 27.5 ng·10^-9, and the sensitivity and specificity were 74.13% and 93.62%, respectively. The optimal cut-off value of SOFA score was 10 points, and the sensitivity and specificity were 70.41% and 87.24%, respectively.Conclusion Elevated value of IL-10/Lym and SOFA score are independent risk factors for 28-day mortality in patients with septic shock, and IL-10/Lym combined with SOFA score had a good clinical value for predicting 28-day mortality risk in patients with septic shock.
- interleukin-10 to lymphocyte ratio /
- sequential organ failure assessment score /
- septic shock /
- predictive value /
- mortality

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图 1 两组患者28 d Kaplan-Meier生存曲线比较

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图 2 SOFA评分、IL-10/Lym及两者联合预测脓毒性休克患者28 d死亡风险的ROC曲线

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表 1 两组患者的临床资料比较例(%)，X±S，M(P₂₅，P₇₅)

指标	存活组(78例)	死亡组(27例)	Z/t/χ²	P
性别/例			0.230	0.631
男	45	17
女	33	10
年龄/岁	60.36±12.08	68.70±8.69	-3.320	0.001
年龄>65岁	25(32.05)	20(74.07)	14.463	< 0.001
BMI	25.56±4.34	24.69±3.84	0.927	0.356
发病至入EICU时间/h	5.14±2.55	5.22±2.69	-0.152	0.880
SOFA评分/分	8.69±1.76	11.82±2.32	-7.293	< 0.001
APACHEⅡ评分/分	17.21±5.54	23.00±7.76	-4.203	< 0.001
基础疾病
慢性心衰	10(12.82)	4(14.81)	0.069	0.793
高血压	20(25.64)	9(33.33)	0.594	0.441
糖尿病	12(15.38)	6(22.22)	0.660	0.416
COPD	10(12.82)	5(18.52)	0.532	0.466
脑血管疾病	17(21.79)	8(29.63)	0.679	0.410
感染部位			1.514	0.679
肺部感染	32(41.03)	10(37.04)
泌尿系感染	18(23.08)	4(14.81)
腹腔感染	24(30.77)	11(40.74)
其他	4(5.13)	2(7.41)
WBC/(×10⁹·L^-1)	15.03±8.40	15.51±8.88	0.252	0.851
Neu/(×10⁹·L^-1)	12.88±7.41	14.34±8.76	-0.840	0.403
Lym/(×10⁹·L^-1)	0.99±0.52	0.79±0.58	1.629	0.111
PCT/(μg·L^-1)	4.76(1.67，13.91)	5.84(2.01，15.32)	-0.851	0.395
CRP/(mg·L^-1)	26.75(21.98，38.55)	27.70(23.80，57.75)	-0.792	0.428
Lac/(mmol·L^-1)	1.70(1.00，2.40)	2.30(1.70，3.80)	-2.682	0.007
IL-10/(ng·L^-1)	8.48(6.15，11.91)	15.62(9.25，33.84)	-4.492	< 0.001
IL-10/Lym/(ng·10^-9)	9.87(5.85，14.91)	32.67(23.45，45.10)	-5.697	< 0.001
注：COPD为慢性阻塞性肺疾病。

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表 2 脓毒性休克患者28 d死亡影响因素的多因素Cox比例风险回归模型分析

项目	β	SE	Wald χ²	HR	95%CI	P
年龄>65岁	1.281	0.492	6.784	3.599	1.373~9.434	0.009
SOFA评分	0.388	0.104	13.803	1.474	1.201~1.808	< 0.001
APACHEⅡ评分	-0.501	0.042	1.500	0.950	0.875~1.031	0.221
Lac	-0.198	0.121	2.673	0.820	0.646~1.050	0.102
IL-10	0.031	0.020	2.430	1.032	0.992~1.073	0.119
IL-10/Lym	0.041	0.014	8.626	1.041	1.014~1.070	0.003

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表 3 SOFA评分、IL-10/Lym及两者联合对脓毒性休克患者28 d死亡风险的ROC曲线分析

指标	AUC	95%CI	临界值	敏感度/%	特异度/%	约登指数
IL-10/Lym	0.869	0.789~0.927	27.5 ng·10^-9	74.13	93.62	0.677
SOFA评分	0.850	0.767~0.912	10分	70.41	87.24	0.576
联合检测	0.931	0.865~0.971	-	74.07	97.44	0.715

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