Evaluating value of interleukin-6 combined with CD4+ T cell percentage on prognosis in patients with sepsis

doi:10.16138/j.1673-6087.2021.06.007

Abstract

Abstract:

Objective To evaluate the value of interleukin （IL）-6 combined with CD4⁺ T lymphocyte percentage on prognosis in the patients with sepsis. Methods The data of 158 patients with sepsis in the emergency medical department of our hospital from June 2016 to June 2019 were collected, which included IL-6 level, CD4⁺ T lymphocyte percentage, CD4⁺ T lymphocyte, C-reactive protein (CRP), procalcitonin (PCT）, human leukocyte DR antigen (HLA-DR), and calculation of patients’ sepsis-related organ failure assessment(SOFA) score and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ) score within 24 h after admission. The patients were divided into survival group and death group according to the prognosis after 28 d, and the difference of the SOFA score, APACHE Ⅱ score, IL-6, CD4⁺ T lymphocyte percentage, the correlation between IL-6, CD4⁺ T lymphocyte percentage and SOFA score was analyzed, the receiver operating characteristic (ROC) curve was drawn, and the prognostic value of IL-6, CD4⁺ T lymphocyte percentage and their combination on the patients with sepsis was evaluated. Results APACHE Ⅱ score (t=4.514, P<0.001), SOFA score (t=4.711, P<0.001), IL-6 (Z=2.114, P=0.035), PCT (t=2.192, P=0.021),CRP (Z=2.208, P=0.033) and D-dimmer (Z=1.963, P=0.043) in the death group were significantly higher than those in the survival group, while the percentage of CD4⁺ T lymphocytes (Z=2.398, P=0.016) and HLA-DR(t=2.004,P=0.040) in the death group were significantly lower than that in the survival group. Spearman correlation analysis of IL-6, CD4⁺ T lymphocyte percentage and SOFA showed that IL-6 was positively correlated with SOFA score (r=0.478, P<0.001) and APACHEⅡscore(r=0.351, P=0.024). CD4⁺ T lymphocyte percentage was negatively correlated with SOFA score(r=-0.305, P=0.043) and APACHEⅡscore(r=-0.347, P=0.031). ROC curve showed that IL-6 combined with CD4⁺ T lymphocyte percentage [area under the curve(AUC)=0.793] had better prognostic value for the patients with sepsis than both APACHE Ⅱ score(AUC=0.732) and SOFA score(AUC=0.750), with sensitivity of 86.7% and specificity of 63.0%. The predictive effect of the combination of two factors was better than that of single index. Conclusions IL-6 combined with CD4⁺T lymphocyte percentage can evaluate the prognosis of the patients with sepsis, and the combination of two indexed is better than using single index.

Key words: Sepsis, Interleukin-6, Percentage of CD4⁺ T lymphocytes

CLC Number:

R631

WANG Hu, ZHANG Jiaojiao, SUN Junnan, WANG Hairong. Evaluating value of interleukin-6 combined with CD4⁺ T cell percentage on prognosis in patients with sepsis[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(06): 404-408.

Figures/Tables 4

References 22

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项目	存活组（n=127）	死亡组（n=31）	t/χ²/Z	P
男性[n（%）]	66（52.0）	18（58.1）	0.372	0.542
年龄（岁）	71.17±16.72	76.23±10.74	1.602	0.111
APACHEⅡ评分（分）	15.39±6.12	21.19±5.94	4.514	<0.001
SOFA评分（分）	5.23±2.94	8.71±3.72	4.711	<0.001
基础疾病[n（%）]
高血压病	73（57.5）	14（45.2）	1.528	0.216
糖尿病	36（28.3）	5（16.1）	1.936	0.164
冠心病	50（39.4）	14（45.2）	0.347	0.556
脑血管疾病	25（19.7）	5（16.1）	0.205	0.651
慢性肾脏病	14（11.0）	3（9.7）	0.047	1.000
原发疾病[n（%）]
肺炎	51（40.2）	14（45.1）	-	-
消化系统感染	21（16.5）	6（19.4）	-	-
泌尿系统感染	14（11.0）	3（9.7）	-	-
颅内感染	11（8.7）	3（9.7）	-	-
其他	30（23.6）	5（16.1）	-	-
PCT（mg/L）	11.09±1.49	24.59±3.90	2.192	0.021
CRP（mg/L）	122.00（62.00,174.00）	160.00（73.00,196.00）	2.208	0.033
IL-6（ng/L）	34.70(15.85,84.70)	138.50(14.50,861.00)	2.114	0.035
HLA-DR	1 865.38±601.41	1 206.74±633.32	2.004	0.040
D-二聚体（mg/L）	1.17（0.73,2.64）	2.86（1.13,5.95）	1.963	0.043
CD4⁺T淋巴细胞（个/μL）	271.8(172.5,432.3)	193.0(84.0,359.0)	1.827	0.068
CD4⁺T细胞百分比（%）	38.07(31.80,45.36)	31.10(19.95,37.50)	2.398	0.016

变量	AUC	P	95%CI	截断值	灵敏度（%）	特异度（%）
SOFA评分	0.750	0.002	0.610~0.890	5.5	80.0	63.0
APACHEⅡ评分	0.732	0.004	0.601~0.862	18.5	66.7	72.2
CD4⁺T淋巴细胞百分比	0.673	0.030	0.505~0.841	35.9	80.1	55.6
IL-6	0.683	0.015	0.520~0.867	68.1	73.3	71.3
PCT	0.694	0.011	0.505~0.861	17.7	75.1	65.3
CRP	0.675	0.038	0.470~0.896	137.0	74.3	61.8
HLA-DR	0.624	0.149	0.416~0.832	1 498.5	50.0	83.7
IL-6联合CD4⁺T细胞百分比	0.793	<0.001	0.684~0.901	0.1	86.7	63.0