血清IL-6、IL-8、TREM1、uPAR和presepsin在脓毒症休克患者中的诊断价值

doi:10.3969/j.issn.1006-5725.2025.18.022

Abstract

Abstract:

Objective To observe the dynamic changes in serum levels of IL-6， IL-8， TREM-1， uPAR， and presepsin in patients with septic shock and to analyze the diagnostic significance of these biomarkers. Methods A total of 150 sepsis patients admitted to the hospital between February 2023 and February 2025 were prospectively enrolled as study subjects. According to their clinical conditions， the participants were categorized into a sepsis group （non-shock， n = 44） and a septic shock group （n = 106）. Additionally， 30 healthy individuals with normal clinical indicators during the same period were selected as the control group. The serum levels of IL-6， IL-8， TREM-1， uPAR， and presepsin were measured and compared across the different groups. Spearman correlation analysis and logistic regression analysis were conducted to assess the association between these biomarkers and the severity of sepsis. The diagnostic performance of these biomarkers for septic shock was evaluated using receiver operating characteristic （ROC） curve analysis. Results There were statistically significant differences in serum levels of IL-6， IL-8， TREM1， uPAR， and presepsin among the different groups （P < 0.05）， with the highest values observed in the septic shock group， followed by the sepsis group and the control group （P < 0.05）. The APACHE Ⅱ and SOFA scores of patients with septic shock were significantly higher than those of patients with sepsis （P < 0.05）. Spearman correlation analysis revealed that serum concentrations of IL-6， IL-8， TREM1， uPAR， and presepsin were positively correlated with both APACHE Ⅱ and SOFA scores， with correlation coefficients （rs） of 0.758， 0.880， 0.837， 0.832， and 0.846 for APACHE Ⅱ score， and 0.487， 0.549， 0.557， 0.626， and 0.664 for SOFA score， respectively （P < 0.05）. Logistic regression analysis indicated that serum levels of IL-6 （OR = 1.055）， IL-8 （OR = 1.054）， TREM1 （OR = 1.038）， uPAR （OR = 1.010）， and presepsin （OR = 2.103） were significantly associated with the development of septic shock （P < 0.05）. ROC curve analysis demonstrated that the AUC values for serum IL-6， IL-8， TREM1， uPAR， and presepsin in diagnosing septic shock were 0.608， 0.724， 0.887， 0.848， and 0.885， with corresponding sensitivities of 0.432， 0.909， 0.795， 0.909， and 0.591， and specificities of 0.880， 0.481， 0.915， 0.736， and 0.977， respectively. When these biomarkers were combined， the AUC increased to 0.973， with a sensitivity of 0.943 and a specificity of 0.953. Furthermore， the AUC for presepsin alone was significantly higher than that for IL-6 and IL-8 alone （P < 0.05）. Additionally， the AUC for the combined biomarkers was significantly greater than that for each biomarker individually （P < 0.05）. Conclusions Serum levels of IL-6， IL-8， TREM1， uPAR， and presepsin are significantly elevated in patients with septic shock， which may aid in the clinical diagnosis of the condition. The combined use of these five biomarkers enhances the accuracy of diagnosing septic shock.

Key words: septic shock, inflammation, immunity, presepsin

CLC Number:

R459.7

E LI,Wuhan HONG,Zhenxian WANG,Rong CHEN. Comparison of the diagnostic value of serum IL⁃6， IL⁃8， TREM1， uPAR and presepsin in patients with septic shock[J]. The Journal of Practical Medicine, 2025, 41(18): 2937-2944.

Figures/Tables 9

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References 29

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项目	脓毒症休克组（n = 44）	脓毒症组（n = 106）	对照组（n = 30）	χ² /F/t值	P值
性别				1.251	0.535
男	26（59.09）	68（64.15）	16（53.30）
女	18（40.91）	38（35.85）	14（46.70）
年龄（x ± s）/岁	65.86 ± 12.35	68.31 ± 14.12	64.20 ± 11.75	1.332	0.266
BMI（x ± s）/（kg/m²）	23.51 ± 3.24	22.74 ± 3.67	24.04 ± 2.80	1.991	0.140
感染类型				0.999	0.802
腹腔感染	12（27.27）	33（31.13）	-
泌尿系感染	11（25.00）	28（26.42）	-
导管相关血流感染	10（22.73）	26（24.53）	-
其他	11（25.00）	19（17.92）	-
糖尿病				0.084	0.772
是	6（13.64）	11（10.38）	-
否	38（86.36）	95（89.62）	-
高血压				0.024	0.880
是	5（11.36）	13（12.26）	-
否	39（88.64）	93（87.74）	-
冠心病				0.901	0.343
是	7（15.91）	11（10.38）	-
否	37（84.09）	95（89.62）	-
心率（x ± s）/（次/min）	86.2 ± 12.43	87.06 ± 12.20	-	0.387	0.699
收缩压（x ± s）/mmHg	108.27 ± 14.39	110.36 ± 13.59	-	0.841	0.402
舒张压（x ± s）/mmHg	63.16 ± 7.58	63.92 ± 7.48	-	0.562	0.575
病原菌感染类型			-	0.414	0.813
革兰阴性菌	21（47.73）	46（43.40）	-
革兰阳性菌	13（29.55）	37（34.90）	-
其他	10（22.72）	23（21.70）	-
白细胞计数（x ± s）/（10⁹·L^-1）	10.13 ± 3.18	10.32 ± 3.23	-	0.342	0.733
血小板计数（x ± s）/（10⁹·L^-1）	175.66 ± 35.21	180.25 ± 33.61	-	0.751	0.454
血肌酐（x ± s）/（μmol/L）	145.26 ± 40.16	140.27 ± 43.28	-	0.657	0.512
血尿素氮（x ± s）/（mmol/L）	10.73 ± 3.18	9.85 ± 2.97	-	1.631	0.105

组别	IL-6/（pg/mL）	IL-8/（pg/mL）	TREM1/（pg/mL）	uPAR/（ng/mL）	presepsin/（pg/mL）
脓毒症休克组（n = 44）	190.88 ± 76.95^?△	113.45 ± 29.05^?△	592.22 ± 65.14^?△	12.19 ± 3.78^?△	1074.04 ± 207.9^?△
脓毒症组（n = 106）	156.73 ± 52.39^?	89.37 ± 28.60^?	486.98 ± 56.72^?	7.29 ± 2.72^?	758.89 ± 169.11^?
对照组（n = 30）	5.18 ± 2.02	12.8 ± 6.48	98.41 ± 28.41	1.85 ± 0.61	198.78 ± 56.3
F值	112.269	138.345	772.056	121.959	245.383
P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	APACHE Ⅱ评分	SOFA评分
脓毒症休克组（n = 44）	23.50（20.00，27.75）	7.50（6.25，9.00）
脓毒症组（n = 106）	18.00（16.00，20.00）	5.00（3.75，6.00）
Z值	-6.861	-7.261
P值	< 0.001	< 0.001

条目	APACHE Ⅱ评分		SOFA评分
条目	r_s 值	P值	r_s 值	P值
IL-6	0.758	< 0.001	0.487	< 0.001
IL-8	0.880	< 0.001	0.549	< 0.001
TREM1	0.837	< 0.001	0.557	< 0.001
uPAR	0.832	< 0.001	0.626	< 0.001
presepsin	0.846	< 0.001	0.664	< 0.001

变量	β	SE	Wald χ²	P值	OR	95%CI
IL-6	0.054	0.015	13.295	0.000	1.055	1.025 ~ 1.087
IL-8	0.052	0.026	4.103	0.043	1.054	1.002 ~ 1.109
TREM1	0.037	0.012	10.184	0.001	1.038	1.014 ~ 1.062
uPAR	0.010	0.004	6.183	0.013	1.010	1.002 ~ 1.017
presepsin	0.743	0.244	9.295	0.002	2.103	1.304 ~ 3.390
常量	22.167	4.777	21.535	0.000	-	-

Comparison of the diagnostic value of serum IL⁃6， IL⁃8， TREM1， uPAR and presepsin in patients with septic shock

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变量	AUC	标准误	P值	95%CI	约登指数	敏感度	特异度	最佳截断值
IL-6	0.608	0.056	0.038	0.498~0.718	0.309	0.432	0.880	214.25 pg/mL
IL-8	0.724	0.045	<0.001	0.637~0.812	0.390	0.909	0.481	84.05 pg/mL
TREM1	0.887	0.031	<0.001	0.826~0.948	0.710	0.795	0.915	515.8 pg/mL
uPAR	0.848	0.035	<0.001	0.779~0.916	0.645	0.909	0.736	11.9 ng/mL
presepsin	0.885	0.033	<0.001	0.819~0.950	0.568	0.591	0.977	922.6 pg/mL
联合	0.973	0.016	<0.001	0.941~1.000	0.896	0.943	0.953	0.734

比较条目	Z值	P值	比较条目	Z值	P值
IL-6 vs. IL-8	-1.619	0.105	IL-8 vs. 联合	-4.271	< 0.001
IL-6 vs. TREM1	-3.337	0.001	TREM1 vs. uPAR	0.882	0.188
IL-6 vs. uPAR	-2.842	0.005	TREM1 vs. presepsin	0.114	0.452
IL-6 vs. presepsin	-3.155	0.002	TREM1 vs. 联合	-3.629	< 0.001
IL-6 vs. 联合	-5.973	< 0.001	uPAR vs. presepsin	-0.527	0.299
IL-8 vs. TREM1	-2.788	0.005	uPAR vs. 联合	-3.796	< 0.001
IL-8 vs. uPAR	-1.587	0.113	presepsin vs. 联合	-3.832	< 0.001
IL-8 vs. presepsin	-2.381	0.017	-	-	-

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