Predictive value of serum changes of PCT, CXCL10 and IFN-γ expression in ICU patients with multidrug-resistant bacterial infections

doi:10.11958/20241944

Abstract

Abstract:

Objective To investigate expression changes of procalcitonin (PCT), C-X-C motif chemokine ligand 10 (CXCL10) and interferon-γ (IFN-γ) in intensive care unit (ICU) patients with multidrug-resistant bacteria organism (MDRO) infection and their therapeutic guidance value. Methods A total of 80 patients with MDRO infection in ICU were selected as the observation group, and another 40 uninfected patients in ICU during the same period were selected as the control group. The patients in the observation group were divided into the effective group (58 cases) and the ineffective group (22 cases) after identification of pathogenic bacteria and drug resistance test. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum PCT, CXCL10 and IFN-γ levels at the time of the control group was enrolled, at the time of the observation group was diagnosed with MDRO infection and at the time after one week of antibiotic treatment. Multifactorial Logistic regression was used to analyse influencing factors of MDRO infection in ICU. Subject work characteristics (ROC) curves were analysed for the predictive value of the difference between serum PCT, CXCL10 and IFN-γ before and after treatment for the effect of antibiotic treatment. Results The proportion of intravenous catheter placement time≥14 d and indwelling urinary catheter time≥14 d in the observation group was higher than that in the control group (P<0.05). Five types of bacteria were cultured in the observation group including Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus. Serum PCT and CXCL10 levels were higher in the observation group than those in the control group, and IFN-γ levels were lower than those in the control group (P<0.05). Elevated serum PCT and CXCL10 levels and reduced IFN-γ levels were risk factors for MDRO infection in ICU (P<0.05). After 1 week of antibiotic treatment, serum PCT and CXCL10 levels were lower in patients in different efficacy groups than those before treatment. IFN-γ levels were higher than before treatment, and the improvement was more obvious in effective patients (P<0.05). The predictive value of the difference between serum PCT, CXCL10 and IFN-γ before and after treatment in combination for the effectiveness of antibiotic treatment in patients with MDRO infection in ICU was better than that of each alone. Conclusion Serum PCT and CXCL10 are elevated and IFN-γ levels are reduced in patients with ICU MDRO infections, and the combined pre- and post-treatment difference between the three has a good predictive value for antibiotic therapy in patients with ICU MDRO infections.

Key words: procalcitonin, chemokine CXCL10, interferon-gamma, intensive care units, multidrug-resistant bacteria organism infection

CLC Number:

R969.3

Figures/Tables 6

References 20

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组别	n	年龄/岁	性别		BMI/（kg/m²）	入住ICU时间		手术次数		低白蛋白血症
组别	n	年龄/岁	男	女	BMI/（kg/m²）	≥30 d	<30 d	≥2次	<2次	低白蛋白血症
对照组	40	51.18±8.34	22（55.00）	18（45.00）	23.16±1.62	15（37.50）	25（62.50）	14（35.00）	26（65.00）	16（40.00）
观察组	80	51.35±9.28	45（56.25）	35（47.35）	23.32±1.55	36（45.00）	44（55.00）	28（35.00）	52（65.00）	40（50.00）
t或χ²		0.098	0.017		0.525	0.614		0		1.071
组别	呼吸机应用时间				静脉置管时间				留置导尿管时间
组别	≥14 d		<14 d		≥14 d		<14 d		≥14 d	<14 d
对照组	16（40.00）		24（60.00）		10（25.00）		30（75.00）		13（32.50）	27（67.50）
观察组	42（52.50）		38（47.50）		46（57.50）		34（42.50）		55（68.75）	25（31.25）
χ²	1.669				11.317^＊				14.270^＊

组别	n	年龄/岁	性别		BMI/（kg/m²）	入住ICU时间		手术次数		低白蛋白血症
组别	n	年龄/岁	男	女	BMI/（kg/m²）	≥30 d	<30 d	≥2次	<2次	低白蛋白血症
对照组	40	51.18±8.34	22（55.00）	18（45.00）	23.16±1.62	15（37.50）	25（62.50）	14（35.00）	26（65.00）	16（40.00）
观察组	80	51.35±9.28	45（56.25）	35（47.35）	23.32±1.55	36（45.00）	44（55.00）	28（35.00）	52（65.00）	40（50.00）
t或χ²		0.098	0.017		0.525	0.614		0		1.071
组别	呼吸机应用时间				静脉置管时间				留置导尿管时间
组别	≥14 d		<14 d		≥14 d		<14 d		≥14 d	<14 d
对照组	16（40.00）		24（60.00）		10（25.00）		30（75.00）		13（32.50）	27（67.50）
观察组	42（52.50）		38（47.50）		46（57.50）		34（42.50）		55（68.75）	25（31.25）
χ²	1.669				11.317^＊				14.270^＊

组别	n	PCT/（μg/L）	CXCL10/（μg/L）	IFN-γ/（ng/L）
对照组	40	0.32±0.06	62.38±19.26	65.39±18.51
观察组	80	2.98±0.65	95.46±22.15	48.55±12.97
t		25.773^＊	8.043^＊	5.151^＊

组别	n	PCT/（μg/L）	CXCL10/（μg/L）	IFN-γ/（ng/L）
对照组	40	0.32±0.06	62.38±19.26	65.39±18.51
观察组	80	2.98±0.65	95.46±22.15	48.55±12.97
t		25.773^＊	8.043^＊	5.151^＊

变量	B	SE	Wald χ²	P	OR	OR95%CI
PCT	0.491	0.129	14.525	<0.001	1.635	1.269~2.105
CXCL10	0.376	0.180	4.372	0.036	1.457	1.023~2.073
IFN-γ	-0.517	0.223	5.385	0.020	0.596	0.384~0.922
静脉置管时间	0.284	0.252	1.274	0.259	1.329	0.810~2.177
留置导尿管时间	0.117	0.209	0.317	0.573	1.125	0.747~1.695
常数项	1.348	0.412	11.336	<0.001	0.000