[Effect of alveolar macrophages phagocytosis on prognosis in patients with acute respiratory distress syndrome caused by abdominal infection: a multicenter study].

OBJECTIVE: To investigate the effects of alveolar macrophage phagocytosis on prognosis in patients with acute respiratory distress syndrome (ARDS) caused by abdominal infection. METHODS: ARDS patients caused by severe intra-abdominal infection admitted to intensive care unit (ICU) of Tianjin Fourth Central Hospital, Tianjin Nankai Hospital, Tianjin First Central Hospital and Tianjin Fifth Central Hospital from June 2016 to March 2018 were enrolled. The gender, age, acute physiology and chronic health evaluation II (APACHE II) within 24 hours of admission, neutral red phagocytosis and alkaline phosphatase activity of macrophages in bronchoalveolar lavage fluid, the length of ICU stay, total hospitalization time, hospitalization expenses, and prognosis were recorded. According to the prognosis, the patients were divided into death group and survival group, and the parameters were compared between the two groups. Pearson test was used to analyze the correlation between neutral red phagocytosis function of macrophages and alkaline phosphatase activity and other indicators. The prognosis was analyzed by binary Logistic regression combined with neutral red phagocytosis and alkaline phosphatase activity in patients, and the predictive value of both subjects on prognosis was analyzed by the receiver operating characteristic (ROC) curve. RESULTS: Twenty patients were enrolled in the study, with 8 in the death group and 12 in the survival group. Compared with the survival group, the death group was older (years old: 58.50±14.86 vs. 46.67±13.40), APACHE II score was higher (21.50±3.93 vs. 13.58±4.12), neutral red phagocytosis ability and alkaline phosphatase activity of alveolar macrophages were significantly decreased (A value: 0.265±0.050 vs. 0.338±0.016; µmol/L: 12.06±1.24 vs. 17.96±3.90), and the length of ICU stay was significantly longer (days: 22.00±14.59 vs. 11.50±3.17), hospitalization cost was significantly increased (10 thousand Yuan: 24.17±11.02 vs. 13.44±3.53), the total hospitalization time was shorter (days: 25.25±15.01 vs. 35.67±8.58), and the difference was statistically significant (all P < 0.05). There was no significant difference in gender between the survival group and the death group [male (case): 8 vs. 6, P > 0.05]. The neutral red phagocytosis ability of alveolar macrophages in ARDS patients caused by abdominal infection was negatively correlated with age, APACHE II score and the length of ICU stay (r value was -0.328, -0.572, -0.809, respectively, all P < 0.05); alkaline phosphatase activity was negatively correlated with age, APACHE II score, the length of ICU stay and hospitalization expenses (r value was -0.334, -0.583, -0.470, -0.517, respectively, all P < 0.05). Binary Logistic regression analysis showed that neutral red phagocytosis [odds ratio (OR) = 0.596, 95% confidence interval (95%CI) = 0.212-0.997] and alkaline phosphatase activity (OR = 0.573, 95%CI = 0.339-0.968) were the influencing factors of prognosis (both P < 0.05). ROC curve analysis showed that the AUC of neutral red phagocytosis ability for prognosis of ARDS patients caused by abdominal infection was 0.948, and the sensitivity and specificity were 91.7% and 87.5% when the off-cut value was 0.317. The AUC of alkaline phosphatase for the prognosis of ARDS patients caused by abdominal infection was 0.813; when the cut-off value was 19.72 µmol/L, the sensitivity was 75.0%, and the specificity was 87.5%. CONCLUSIONS: The alveolar macrophage phagocytosis dysfunction in ARDS patients caused by severe abdominal infection was not only related to the severity of the disease, but also increased the medical burden of patients, and significantly affected the mortality of such patients.

[The influence of sex hormones on human leukocyte antigen-DR, soluble myeloid cell receptor-1 and prognosis in patients with severe intra-abdominal infection].

OBJECTIVE: To evaluate the influence of serum estradiol, prolactin and testosterone levels on human leukocyte antigen-DR (HLA-DR), soluble myeloid cell receptor-1 (sTREM-1) and prognosis in patients with severe abdominal infection, in order to evaluate the clinical value of the above-mentioned sex hormones. METHODS: From July 10, 2009 to February 9, 2010, 73 cases with severe intra-abdominal infections hospitalized in surgical intensive care unit (ICU) of Tianjin Nankai Hospital were enrolled. Within 72 hours after enrollment, serum estradiol, prolactin and testosterone levels were detected by radioimmunoassay. Based on their levels, all the cases were divided into increased estradiol group (n=38) and non-increased estradiol group (n=35), increased prolactin group (n=28) and non-increased prolactin group (n=45), decreased testosterone group (n=33) and non-decreased testosterone group (n=40) respectively. In addition, HLA-DR (flow cytometry), as well as of sTREM-1 (enzyme linked immunosorbent assay), acute physiology and chronic health evaluation II (APACHEII) score, hospital days, the ICU length, hospital costs and 28 day mortality were recorded. RESULTS: Compared with non-increased estradiol group, HLA-DR in increased estradiol group decreased significantly [(61.22±22.39)% vs. (75.09±14.85)%], while sTREM-1 (ng/L) increased obviously (291.59±148.13 vs. 216.48±124.82), APACHEII score lowered dramatically (11.47±6.88 vs. 15.36±8.79), hospital costs (ten thousands) raised significantly (10.98±8.15 vs 6.25±3.51), ICU length (days) was much shorter (8.56±4.05 vs. 12.17±7.99), and 28 days mortality was significantly lowered (10.00% vs. 32.75%,P<0.05 or P<0.01). Compared with non-increased prolactin group, increased prolactin group had much lower HLA-DR levels [(61.19±21.50)% vs. (72.02±18.49)%], higher sTREM-1 levels (307.92±173.93 vs. 223.01±106.93), at the same time, their cost of hospitalization (7.75±3.52 vs. 11.36±8.24) and ICU stay length (9.14±3.15 vs. 13.24±2.16) were significantly lower (all P<0.05). Compared with non-decreased testosterone group, HLA-DR in decreased testosterone group increased significantly [(74.69±14.72)% vs. (62.24±22.54)%], while sTREM-1 decreased obviously (208.77±77.80 vs. 294.20±169.36), APACHEII score lowered dramatically (10.57±6.97 vs. 15.39±9.46), hospital costs decreased significantly (7.67±3.81 vs. 11.19±8.05), and 28 days mortality lowered significantly (0 vs. 30.14%, P<0.05 or P<0.01). CONCLUSIONS: In the early stage of severe intra-abdominal infection, estrogen, prolactin and testosterone levels had powerful influences on immune, inflammation, and prognosis, which may indicated a widespread clinical application.

[The effect of changes in the level of sex hormone on prognosis of abdominal surgical systemic inflammatory response syndrome].

OBJECTIVE: To examine if the serum level of 3 sex hormones early after admission are correlated with the prognosis in post-abdominal surgery patients with systemic inflammatory response syndrome (SIRS). METHODS: 39 patients admitted to our surgical intensive care unit (SICU) for abdominal surgery were divided, according to their serum level of estradiol (E2), prolactin (PRL), and testosterone (TT), into: (1) E2 elevation group (n = 20), (2) E2 normal group (n = 19), (3) PRL elevation group (n = 16), (4) PRL normal group (n = 23), (5) TT reduction group (n = 14), and (6) TT normal group (n = 25), for data collection of: acute physiology and chronic health evaluation II(APACHE II) scores, total hospitalization days, ICU stay, total hospitalization cost and 28 day outcomes. RESULTS: In comparison with corresponding normal group, E2 elevation group had lower (but not statistically significant) APACHE II score (11.6 ± 7.8 vs. 15.2 ± 8.8, P > 0.05), significantly shorter ICU stay (days: 8.5 ± 4.0 vs. 12.1 ± 7.9, P < 0.05), and significantly lower 28 days mortality rate (10.0% vs. 35.7%, P < 0.05); PRL elevation group had significantly shorter ICU stay (days: 8.7 ± 3.1 vs. 12.9 ± 2.1, P < 0.01), and significantly lower total hospitalization cost (thousand yuan: 6.70 ± 3.50 vs. 13.20 ± 8.20, P < 0.05); TT reduction group had significantly lower APACHE II score (10.4 ± 5.4 vs. 15.2 ± 9.4, P < 0.05), significantly shorter ICU stay (days: 26.6 ± 12.2 vs. 28.1 ± 17.0, P < 0.01), and significantly lower 28-day mortality rate (0 vs. 31.8%, P < 0.01). CONCLUSION: The early serum levels of sex hormones may have significant influence on the prognosis in post-abdominal surgery patients with SIRS.