중증 패혈증 및 패혈쇼크 환자들의 28일째 사망 예측 인자로서 미성숙 과립구의 평가 (Validation of Immature Granulocyte as a Predictor for the 28-Day Mortality in Patients with Severe Sepsis and Septic Shock)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 25권 / 2호 / 167 ~ 173페이지
· 저자명 : 고영상, 하상욱, 정루비, 최병호

초록

Purpose: Recently, several studies for immature granulocyteproportion (IG%) in patients with sepsis have revealedits association with diagnosis and prognosis of patients withsepsis. In this study, we enrolled patients with severe sepsisand septic shock and compared IG% with other biologicmarkers as a predictor of 28-day mortality.
Methods: This was a retrospective study for patients withsevere sepsis and septic shock who were admitted to theemergency department of a tertiary care hospital for fourmonths.
The IG% measured using Sysmex XE-2100 andother inflammatory markers, including C-reactive protein,lactate, and procalcitonin were evaluated and compared for28-day mortality.
Results: A total of 85 patients with septic shock and 45patients with severe sepsis were enrolled. In the non-survivorsgroup (n=32, 24.6%), APACHE II score (p=0.017),use of continuous renal replacement therapy (CRRT)(p=0.002), and septic shock (p=0.009) were statisticallyhigher compared with thesurvivors group. APACHE IIscore (Odd ratio [OR] 1.099, p=0.008) and IG% (≥0.5%)(OR 3.568, p=0.036) predicted the 28-day mortality independentlyafter adjusting SOFA score, septic shock,disseminatedintravascular coagulopathy, use of CRRT, andgender. However, IG (≥0.5%) had low specificity of 33.7%and positive predictive value (PPV) of 30.1% for 28-daymortality.
Conclusion: IG% could be a useful biologic marker for predictionof 28-day mortality in patients with severe sepsis orseptic shock. However, the limitation of low specificity andPPV must be considered in clinical use.

영어초록

Purpose: Recently, several studies for immature granulocyteproportion (IG%) in patients with sepsis have revealedits association with diagnosis and prognosis of patients withsepsis. In this study, we enrolled patients with severe sepsisand septic shock and compared IG% with other biologicmarkers as a predictor of 28-day mortality.
Methods: This was a retrospective study for patients withsevere sepsis and septic shock who were admitted to theemergency department of a tertiary care hospital for fourmonths.
The IG% measured using Sysmex XE-2100 andother inflammatory markers, including C-reactive protein,lactate, and procalcitonin were evaluated and compared for28-day mortality.
Results: A total of 85 patients with septic shock and 45patients with severe sepsis were enrolled. In the non-survivorsgroup (n=32, 24.6%), APACHE II score (p=0.017),use of continuous renal replacement therapy (CRRT)(p=0.002), and septic shock (p=0.009) were statisticallyhigher compared with thesurvivors group. APACHE IIscore (Odd ratio [OR] 1.099, p=0.008) and IG% (≥0.5%)(OR 3.568, p=0.036) predicted the 28-day mortality independentlyafter adjusting SOFA score, septic shock,disseminatedintravascular coagulopathy, use of CRRT, andgender. However, IG (≥0.5%) had low specificity of 33.7%and positive predictive value (PPV) of 30.1% for 28-daymortality.
Conclusion: IG% could be a useful biologic marker for predictionof 28-day mortality in patients with severe sepsis orseptic shock. However, the limitation of low specificity andPPV must be considered in clinical use.

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