与念珠菌血症患者短期死亡率相关的风险因素及血清细胞因子水平的预测价值。

IF 3.7 3区医学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY

Cytokine Pub Date : 2024-11-15 DOI:10.1016/j.cyto.2024.156803

Xueqing Fang , Congling Su , Yan Luo , Kai Pan , Jian Lin , Youliang Song , Yize Huang , Xiaochun Hu , Zhiyong Shen

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引用次数: 0

摘要

背景：一些促炎和抗炎细胞因子在念珠菌血症患者中明显升高，但还没有研究将这些细胞因子纳入念珠菌血症死亡率的风险因素分析中。本研究旨在分析念珠菌病短期死亡率的风险因素以及血清细胞因子的预测价值：我们回顾性分析并比较了 53 例念珠菌病患者的临床特征、风险因素以及白细胞介素（IL）-6、干扰素-γ（IFN-γ）、IL-10 和 IL-17 等细胞因子在生存组和死亡组之间的差异。结果显示，53 例念珠菌血症患者中，存活组与死亡组之间的干扰素-γ（IFN-γ，IL-6）、IL-10、IL-17的预测能力存在差异：念珠菌血症的总体院内死亡率为 62.3%（33/53），30 天死亡率为 52.8%（28/53）。白念珠菌占 17.0%（9/53），非白念珠菌占 83.0%（44/53）。血清 IL-6（p = 0.041，HR = 1.009）、IFN-γ（p = 0.013，HR = 1.007，95 %）、降钙素原（PCT）（p = 0.010，HR = 0.899）和念珠菌评分（p = 0.033，HR = 1.而在血培养（BC）阳性 48 小时内开始针对性抗真菌治疗（P = 0.015，HR = 0.266）则是一个保护因素。念珠菌评分、血清 IL-6、PCT、IFN-γ 和 BC 阳性 48 小时内开始抗真菌靶向治疗的 ROC AUC 分别为 0.933、0.841、0.801、0.732、0.714。IL-6和IFN-γ是预测30天和90天死亡率的良好模型，而IL-6和IL-10是预测90天死亡率的最佳组合：结论：血清 IL-6、IFN-γ、PCT 和念珠菌评分可预测念珠菌血症患者的短期死亡风险，而及时、有针对性的抗真菌治疗可降低死亡率。IL-6可作为预测念珠菌血症短期死亡率的生物标志物，与IL-10或IFN-γ结合使用可进一步提高预测价值。

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Risk factors associated with short-term mortality in patients with candidemia and the predictive value of serum cytokine level

Background

Some pro-inflammatory and anti-inflammatory cytokines were significantly elevated in patients with candidemia patients, but no studies have included these cytokines in the analysis of risk factors for mortality of candidemia. This study aims to analyze the risk factors of short-term mortality of candidemia and the predictive value of serum cytokines.

Methods

We retrospectively analyzed and compared the clinical features, risk factors and cytokine interleukin (IL)-6, interferon-γ (IFN-γ), IL-10 and IL-17 between survival group and death group in 53 patients with candidemia. Receiver operating of the characteristic curve (ROC) analysis was performed and figured up area under the curve (AUC), sensitivity and specificity values to assess the predictive power of independent factors associated with mortality.

Results

The overall in-hospital mortality rate of candidemia was 62.3 % (33/53), and the 30-day mortality rate was 52.8 % (28/53). The C. albicans accounting for 17.0 % (9/53), and the non-albicans Candida was 83.0 % (44/53). Serum IL-6 (p = 0.041, HR = 1.009), IFN-γ (p = 0.013, HR = 1.007, 95 %), procalcitonin (PCT) (p = 0.010, HR = 0.899) and Candida score (p = 0.033, HR = 1.659) were independent risk factors, while Initiation of targeted antifungal therapy within 48 h of positive blood cultures (BC) (P = 0.015, HR = 0.266) was a protective factor. The AUC of ROC for Candida score, serum IL-6, PCT, IFN-γ, and Initiation of targeted antifungal therapy within 48 h of positive BC showed 0.933, 0.841, 0.801, 0.732, 0.714, respectively. IL-6 and IFN-γ comprised good performing model for predicting 30-day and 90-day mortality, while IL-6 and IL-10 were the best combinations for predicting 90-day mortality.

Conclusions

Serum IL-6, IFN-γ, PCT, and Candida score can predict short-term mortality risk in patients with candidemia, while prompt and targeted antifungal treatment may reduce mortality. IL-6 could serve as a possible biomarker for predicting short-term mortality of candidemia and its combination with IL-10 or IFN-γ may further improve the predictive value.

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来源期刊

Cytokine 医学-免疫学

CiteScore

7.60

自引率

2.60%

发文量

262

审稿时长

48 days

期刊介绍： The journal Cytokine has an open access mirror journal Cytokine: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. * Devoted exclusively to the study of the molecular biology, genetics, biochemistry, immunology, genome-wide association studies, pathobiology, diagnostic and clinical applications of all known interleukins, hematopoietic factors, growth factors, cytotoxins, interferons, new cytokines, and chemokines, Cytokine provides comprehensive coverage of cytokines and their mechanisms of actions, 12 times a year by publishing original high quality refereed scientific papers from prominent investigators in both the academic and industrial sectors. We will publish 3 major types of manuscripts: 1) Original manuscripts describing research results. 2) Basic and clinical reviews describing cytokine actions and regulation. 3) Short commentaries/perspectives on recently published aspects of cytokines, pathogenesis and clinical results.