Influencing factors and prognostic value of ESR, hs-CRP, IL-6 and D-D in patients with tuberculous polyserous effusion

doi:10.11958/20221856

Abstract

Abstract:

Objective To explore the influencing factors of prognostic value of erythrocyte sedimentation rate (ESR), interleukin (IL) -6, hypersensitive C-reactive protein (hs-CRP) and D-dimer (D-D) in patients with tuberculous polyserous effusion. Methods A total of 228 hospitalized patients with tuberculous polyserous effusion were collected and divided into the poor prognosis group (89 cases) and the good prognosis group (139 cases) according to the outcome. Baseline characteristics, tuberculosis disease related data and leukocyte (WBC), neutrophil ratio (neutrophil %), ESR, PLT, procalcitonin (PCT), hs-CRP, IL-6, serum albumin (ALB) and D-D were collected within 24 h after admission. Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis in inpatients with tuberculous polyserous effusion. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of each indicator for poor prognosis. Results Levels of NEUT%, ESR, hs-CRP, IL-6 and D-D were significantly higher in the poor prognosis group than those in the good prognosis group (P<0.05). Increased levels of ESR, hs-CRP, IL-6 and D-D were risk factors for poor prognosis in inpatients with tuberculous polyserous effusion (P<0.05). The joint prediction model was established as logit (P) =-6.650+0.050×(ESR)+0.008×(hs-CRP)+0.024×(IL-6)+0.251×(D-D). ROC curve analysis showed that the largest area under the curve (AUC) was ESR, which was 0.819 (95%CI: 0.766-0.873). The AUC of ESR+IL-6+hs-CRP+D-D combined detection was 0.905 (95%CI: 0.865-0.945). Conclusion The combined detection of ESR, hs-CRP, IL-6 and D-D has a certain predictive value for the prognosis of tuberculous polyserous effusion.

Key words: tuberculosis, pleural effusion, blood sedimentation, C-reactive protein, interleukin-6, fibrin fibrinogen degradation products, prognosis, polyserositis

CLC Number:

Figures/Tables 8

Tab.1 Comparison of general data between the good prognosis group and the poor prognosis group

组别	n		年龄（岁）	性别（男/女）		民族（汉族/其他）	发病时间（<2周/2周~ 1个月/>1个月）					结核治疗史（初治/复治）			合并其他部位结核感染（是/否）			糖尿病病史（有/无）
预后良好组	139		53（28，67）	85/54		123/16	44/60/35					134/5			124/15			11/128
预后不良组	89		53（31，68）	50/39		82/7	20/36/33					83/6			81/8			5/84
Z、χ²或P			0.319	0.555		0.795	4.301					0.347^▲			0.194			0.438
组别		PPD试验（阴性/弱阳性/阳性/强阳性）			痰结核杆菌抗酸染色涂片（阴性/阳性）			发病部位
组别		PPD试验（阴性/弱阳性/阳性/强阳性）			痰结核杆菌抗酸染色涂片（阴性/阳性）			①	②	③	④		⑤	⑥		⑦	⑧	⑨	⑩
预后良好组		85/6/34/14			120/19			12	3	3	9		12	1		43	25	29	2
预后不良组		65/5/11/8			75/14			7	2	0	7		1	3		38	11	20	0
χ²或P		0.130^▲			0.186			0.102^▲

Tab.2 Comparison of laboratory indexes between the poor prognosis group and the good prognosis group

组别		n	WBC（×10⁹/L）		NEUT%		PLT（×10⁹/L）
预后良好组		139	6.13（4.79，8.04）		73.40（67.80，81.20）		287（210，396）
预后不良组		89	6.82（4.94，8.91）		76.70（70.90，82.97）		302（204，411）
Z			1.349		2.059^＊		0.534
组别	ESR（mm/1 h）			PCT（μg/L）		hs-CRP（mg/L）
预后良好组	32（15，47）			0.159（0.056，0.308）		44.45（17.15，109.85）
预后不良组	62（40，88）			0.168（0.063，0.245）		159.92（55.86，282.77）
Z	8.134^＊＊			1.187		7.301^＊＊
组别			IL-6（ng/L）			ALB（g/L）	D-D（mg/L）
预后良好组			27.17（12.99，63.35）			31.71 $±$ 5.75	2.46（1.38，3.24）
预后不良组			77.27（39.71，115.85）			31.83 $±$ 6.52	2.83（1.59，3.60）
t或Z			7.064^＊＊			0.514	1.983^＊

Tab.2 Comparison of laboratory indexes between the poor prognosis group and the good prognosis group

组别		n	WBC（×10⁹/L）		NEUT%		PLT（×10⁹/L）
预后良好组		139	6.13（4.79，8.04）		73.40（67.80，81.20）		287（210，396）
预后不良组		89	6.82（4.94，8.91）		76.70（70.90，82.97）		302（204，411）
Z			1.349		2.059^＊		0.534
组别	ESR（mm/1 h）			PCT（μg/L）		hs-CRP（mg/L）
预后良好组	32（15，47）			0.159（0.056，0.308）		44.45（17.15，109.85）
预后不良组	62（40，88）			0.168（0.063，0.245）		159.92（55.86，282.77）
Z	8.134^＊＊			1.187		7.301^＊＊
组别			IL-6（ng/L）			ALB（g/L）	D-D（mg/L）
预后良好组			27.17（12.99，63.35）			31.71 $±$ 5.75	2.46（1.38，3.24）
预后不良组			77.27（39.71，115.85）			31.83 $±$ 6.52	2.83（1.59，3.60）
t或Z			7.064^＊＊			0.514	1.983^＊

Tab.3 Logistic regression analysis of factors affecting poor prognosis of hospitalized patients with tuberculous polyserous effusion

变量	B	SE	Wald χ²	P	OR	OR 95%CI
NEUT%	0.014	0.018	0.652	0.419	1.014	0.980~1.050
ESR	0.050	0.010	27.820	<0.001	1.051	1.032~1.071
hs-CRP	0.008	0.002	9.736	0.002	1.008	1.003~1.012
IL-6	0.024	0.006	14.560	<0.001	1.024	1.012~1.037
D-D	0.251	0.114	4.830	0.028	1.285	1.027~1.607
常数项	-6.650	1.528	18.940	<0.001	0.001

Tab.4 Analysis of the diagnostic value of single index for poor prognosis

指标	AUC（95%CI）	P	临界值	敏感度（%）	特异度（%）	约登指数
ESR	0.819（0.766~0.873）	<0.001	48.50 mm/1 h	67.4	77.0	0.444
hs-CRP	0.787（0.728~0.846）	<0.001	212.09 mg/L	44.9	98.6	0.435
IL-6	0.777（0.717~0.838）	<0.001	76.06 ng/L	51.7	92.1	0.438
D-D	0.578（0.500~0.656）	0.048	2.65 mg/L	59.6	69.8	0.293

Fig.1 Analysis of the diagnostic value of single index in poor prognosis of tuberculous pleural effusion

Fig.2 Analysis of the diagnostic value of the combination of the two indexes for the poor prognosis of tuberculous pleural effusion

Fig.3 Analysis of the diagnostic value of three and four indexes combined in poor prognosis of tuberculous pleural effusion

Tab.5 Analysis of the diagnostic value of multiple indexes combined with indexes for poor prognosis

指标	AUC（95%CI）	P	敏感度（%）	特异度（%）	约登指数
ESR+IL-6	0.881（0.835~0.927）	<0.001	77.5	87.1	0.646
ESR+hs-CRP	0.875（0.829~0.920）	<0.001	67.4	92.8	0.602
ESR+D-D	0.823（0.770~0.876）	<0.001	56.2	90.6	0.468
IL-6+hs-CRP	0.826（0.772~0.881）	<0.001	65.2	89.2	0.544
IL-6+D-D	0.784（0.724~0.844）	<0.001	57.3	85.6	0.429
hs-CRP+D-D	0.804（0.747~0.861）	<0.001	82.0	64.0	0.461
ESR+IL-6+hs-CRP	0.896（0.854~0.938）	<0.001	83.1	83.5	0.666
ESR+IL-6+D-D	0.889（0.845~0.932）	<0.001	75.3	89.9	0.599
ESR+hs-CRP+D-D	0.878（0.832~0.923）	<0.001	76.4	83.5	0.652
IL-6+hs-CRP+D-D	0.846（0.795~0.897）	<0.001	64.0	90.6	0.547
ESR+IL-6+hs-CRP+D-D	0.905（0.865~0.945）	<0.001	85.4	80.6	0.660

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