Background:Sepsis is a life-threatening condition caused by a dysregulated host response to infection,leading to organ dysfunction.Early diagnosis and accurate prognosis are crucial for improving patient outcomes.Trad...Background:Sepsis is a life-threatening condition caused by a dysregulated host response to infection,leading to organ dysfunction.Early diagnosis and accurate prognosis are crucial for improving patient outcomes.Traditional biomarkers such as C-reactive protein(CRP)and procalcitonin(PCT)are widely used but have limitations in sensitivity and specificity.Monocytic human leukocyte antigen-DR(mHLA-DR)has emerged as a promising immunological marker reflecting immune status and severity in sepsis patients.This study aimed to compare the clinical value of mHLA-DR,PCT,and CRP in diagnosing and predicting sepsis outcomes,providing better guidance for clinical management.Methods:A retrospective analysis was conducted on 83 sepsis patients and 86 non-sepsis patients admitted to the ICU of our hospital between August 2018 and July 2023.Sepsis patients with clear prognostic outcomes were divided into a survival(24 cases)and death groups(41 cases).Flow cytometry was used to detect mHLA-DR expression,while serum PCT and CRP levels were measured using an automated biochemical immunoassay analyzer.Differences in these indicators were compared between the sepsis and non-sepsis groups as well as between the survival and death groups.Receiver operating characteristic(ROC)curves were employed to analyze the diagnostic and prognostic values of these markers in sepsis.Results:The mHLA-DR,PCT,and CRP levels were significantly higher in the sepsis group compared with the non-sepsis group(p<0.001).The area under the ROC curve(AUC)values for diagnosing sepsis were 0.780 for mHLA-DR,0.837 for PCT,and 0.839 for CRP,with optimal diagnostic cutoff values of 49.46%,1.95 ng/mL,and 67.91 mg/L,respectively.The respective sensitivities were 76.7%,86.7%,and 88.0%,while the respective specificities were 75.9%,70.9%,and 64.0%.The combined analysis of these three indicators yielded an AUC value of 0.890 with an 86.7%sensitivity and 75.6%specificity.In the sepsis cohort,mHLA-DR expression levels were significantly higher in the survival group compared with the death group(p<0.001),while PCT levels were significantly lower in the survival group(p=0.045).CRP levels showed no significant difference between the survival and death groups(p=0.833).The prognostic efficacy of mHLA-DR was significantly superior to that of PCT,with mHLA-DR displaying an AUC value of 0.841,an optimal cutoff value of 30.14%,and an 87.5%sensitivity and 73.2%specificity.展开更多
目的分析单核细胞人白细胞DR抗原(mHLA-DR)、中性粒细胞与淋巴细胞比值(NLR)及CD4^(+)T淋巴细胞对脓毒症患者预后的预测价值.方法收集2023年12月至2024年9月入住青岛市市立医院重症医学科的29例脓毒症患作为研究对象,根据28 d预后将患...目的分析单核细胞人白细胞DR抗原(mHLA-DR)、中性粒细胞与淋巴细胞比值(NLR)及CD4^(+)T淋巴细胞对脓毒症患者预后的预测价值.方法收集2023年12月至2024年9月入住青岛市市立医院重症医学科的29例脓毒症患作为研究对象,根据28 d预后将患者分为存活组(20例)与死亡组(9例).收集患者入院时的基线资料[包括患者的性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、白细胞计数(WBC)、NLR、血红蛋白(Hb)、血小板计数(PLT)、C-反应蛋白(CRP)、总蛋白(TP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Cr)、CD4^(+)T淋巴细胞计数]和入院1、3、7 d mHLA-DR水平,并计算入院3 d、7 d mHLA-DR表达率与入院1 d的差值,记为ΔH3、ΔH7.比较不同预后两组患者上述指标的差异.绘制受试者工作特征曲线(ROC曲线)评价mHLA-DR、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分对脓毒症患者28 d死亡风险的预测价值.结果与存活组比较,死亡组APACHEⅡ评分、SOFA评分、NLR均明显升高,ΔH7、CD4^(+)T淋巴细胞计数均明显降低(均P<0.05).ROC曲线分析显示:ΔH7、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分均对脓毒症患者28 d预后均有预测价值,ROC曲线下面积(AUC)和95%可信区间(95%CI)分别为0.817(0.635~0.999)、0.789(0.611~0.966)、0.786(0.588~0.985)、0.853(0.685~1.000)、0.844(0.659~1.000),均P<0.05.ΔH7联合NLR、ΔH7联合CD4^(+)T淋巴细胞、NLR联合CD4^(+)T淋巴细胞以及ΔH7、NLR、CD4^(+)T淋巴细胞3者联合检测对脓毒症患者28 d预后亦有预测价值,AUC和95%CI分别为0.867(0.735~0.998)、0.878(0.752~1.000)、0.883(0.760~1.000)、0.928(0.837~1.000),均P<0.05.结论脓毒症患者入院1 d NLR及CD4^(+)T淋巴细胞计数可预测脓毒症患者预后,动态监测脓毒症患者mHLA-DR水平同样可以预测脓毒症患者预后,然而7 d内单次测定mHLA-DR水平没有意义.就单指标而言,ΔH7在ΔH7、NLR、CD4^(+)T淋巴细胞计数3个指标中对于脓毒症患者预后的预测价值最佳,3个指标联合检测对脓毒症患者预后判断更具优势.展开更多
基金supported by Beijing High-level Public Health Technical Personnel Project(2023-03-03)Wu Jieping Medical Foundation Clinical Research Special Funding(320.6750.2022-26-2).
文摘Background:Sepsis is a life-threatening condition caused by a dysregulated host response to infection,leading to organ dysfunction.Early diagnosis and accurate prognosis are crucial for improving patient outcomes.Traditional biomarkers such as C-reactive protein(CRP)and procalcitonin(PCT)are widely used but have limitations in sensitivity and specificity.Monocytic human leukocyte antigen-DR(mHLA-DR)has emerged as a promising immunological marker reflecting immune status and severity in sepsis patients.This study aimed to compare the clinical value of mHLA-DR,PCT,and CRP in diagnosing and predicting sepsis outcomes,providing better guidance for clinical management.Methods:A retrospective analysis was conducted on 83 sepsis patients and 86 non-sepsis patients admitted to the ICU of our hospital between August 2018 and July 2023.Sepsis patients with clear prognostic outcomes were divided into a survival(24 cases)and death groups(41 cases).Flow cytometry was used to detect mHLA-DR expression,while serum PCT and CRP levels were measured using an automated biochemical immunoassay analyzer.Differences in these indicators were compared between the sepsis and non-sepsis groups as well as between the survival and death groups.Receiver operating characteristic(ROC)curves were employed to analyze the diagnostic and prognostic values of these markers in sepsis.Results:The mHLA-DR,PCT,and CRP levels were significantly higher in the sepsis group compared with the non-sepsis group(p<0.001).The area under the ROC curve(AUC)values for diagnosing sepsis were 0.780 for mHLA-DR,0.837 for PCT,and 0.839 for CRP,with optimal diagnostic cutoff values of 49.46%,1.95 ng/mL,and 67.91 mg/L,respectively.The respective sensitivities were 76.7%,86.7%,and 88.0%,while the respective specificities were 75.9%,70.9%,and 64.0%.The combined analysis of these three indicators yielded an AUC value of 0.890 with an 86.7%sensitivity and 75.6%specificity.In the sepsis cohort,mHLA-DR expression levels were significantly higher in the survival group compared with the death group(p<0.001),while PCT levels were significantly lower in the survival group(p=0.045).CRP levels showed no significant difference between the survival and death groups(p=0.833).The prognostic efficacy of mHLA-DR was significantly superior to that of PCT,with mHLA-DR displaying an AUC value of 0.841,an optimal cutoff value of 30.14%,and an 87.5%sensitivity and 73.2%specificity.
文摘目的分析单核细胞人白细胞DR抗原(mHLA-DR)、中性粒细胞与淋巴细胞比值(NLR)及CD4^(+)T淋巴细胞对脓毒症患者预后的预测价值.方法收集2023年12月至2024年9月入住青岛市市立医院重症医学科的29例脓毒症患作为研究对象,根据28 d预后将患者分为存活组(20例)与死亡组(9例).收集患者入院时的基线资料[包括患者的性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、白细胞计数(WBC)、NLR、血红蛋白(Hb)、血小板计数(PLT)、C-反应蛋白(CRP)、总蛋白(TP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Cr)、CD4^(+)T淋巴细胞计数]和入院1、3、7 d mHLA-DR水平,并计算入院3 d、7 d mHLA-DR表达率与入院1 d的差值,记为ΔH3、ΔH7.比较不同预后两组患者上述指标的差异.绘制受试者工作特征曲线(ROC曲线)评价mHLA-DR、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分对脓毒症患者28 d死亡风险的预测价值.结果与存活组比较,死亡组APACHEⅡ评分、SOFA评分、NLR均明显升高,ΔH7、CD4^(+)T淋巴细胞计数均明显降低(均P<0.05).ROC曲线分析显示:ΔH7、NLR、CD4^(+)T淋巴细胞计数、SOFA评分及APACHEⅡ评分均对脓毒症患者28 d预后均有预测价值,ROC曲线下面积(AUC)和95%可信区间(95%CI)分别为0.817(0.635~0.999)、0.789(0.611~0.966)、0.786(0.588~0.985)、0.853(0.685~1.000)、0.844(0.659~1.000),均P<0.05.ΔH7联合NLR、ΔH7联合CD4^(+)T淋巴细胞、NLR联合CD4^(+)T淋巴细胞以及ΔH7、NLR、CD4^(+)T淋巴细胞3者联合检测对脓毒症患者28 d预后亦有预测价值,AUC和95%CI分别为0.867(0.735~0.998)、0.878(0.752~1.000)、0.883(0.760~1.000)、0.928(0.837~1.000),均P<0.05.结论脓毒症患者入院1 d NLR及CD4^(+)T淋巴细胞计数可预测脓毒症患者预后,动态监测脓毒症患者mHLA-DR水平同样可以预测脓毒症患者预后,然而7 d内单次测定mHLA-DR水平没有意义.就单指标而言,ΔH7在ΔH7、NLR、CD4^(+)T淋巴细胞计数3个指标中对于脓毒症患者预后的预测价值最佳,3个指标联合检测对脓毒症患者预后判断更具优势.
