Table 4.
Association between early changes in cytokine levels and adverse outcomes
| Outcome | Hospital mortality ODL(Sensitivity, specificity)1 Odds Ratio2 (95% CI) AUC (95% CI) |
Acute Kidney Injury ODL (Sensitivity, specificity) Odds Ratio (95% CI) AUC (95% CI) |
Nosocomial Infections ODL (Sensitivity, specificity) Odds Ratio (95% CI) AUC (95% CI) |
|---|---|---|---|
| Clinical Model (CM)3 | |||
| APACHE II | 1.14 (0.96, 1.34) | 1.02 (0.94, 1.10) | 1.08 ( 1.00, 1.15) |
| ISS | 1.02 (0.95, 1.08) | 1.00 (0.97, 1.04) | 1.03 (0.99, 1.06) |
| 0.67 (0.46, 0.88) | 0.49 (0.37, 0.61) | 0.66 (0.57, 0.75) | |
|
| |||
| CM and IL1ra (pg/ml) | (>) 14558 (0.43, 0.90) | (>) 4763 (0.59, 0.84) | (<) 36 (0.28, 0.86) |
| 3.54 (0.57, 22.14) | 7.87 (3.19, 19.41) | 2.48 (0.97, 6.31) | |
| 0.70 (0.48, 0.92) | 0.74 ( 0.63, 0.84)* | 0.69 (0.60, 0.78) | |
|
| |||
| CM and sIL1R2 (pg/ml) | (>) 5022 (0.71, 0.72) | (>) 5022 (0.5, 0.76) | (>) 8161 (0.24, 0.83) |
| 4.2(0.85, 21.58) | 2.84 (1.22, 6.59) | 1.58 (0.63, 3.92) | |
| 0.77 (0.58, 0.96) | 0.61 (0.49, 0.73) | 0.67 ( 0.58, 0.77) | |
|
| |||
| CM and IL4 (pg/ml) | (<) 60 (0.71, 0.72) | (<) 77 (0.47, 0.71) | (>) 725 (0.18, 0.98) |
| 4.1 (0.81,20.49) | 2.15 (0.95, 4.90) | 10.38 (1.27, 84.60) | |
| 0.78 (0.61, 0.97) | 0.59 (0.48, 0.71) | 0.71 (0.62, 0.80) | |
|
| |||
| CM and IL10 (pg/ml) | (<) 28 (0.29, 0.98) | (<) 482 (0.84, 0.35) | (<) 107 (0.61, 0.54) |
| 15.81 (1.93, 129.66) | 2.39 (0.90, 6.37) | 0.54 (0.26, 1.12) | |
| 0.72 ( 0.49, 0.96) | 0.56 (0.45, 0.66) | 0.68 (0.59, 0.77) | |
|
| |||
| CM and sTNFR2 (pg/ml) | (<) 69069 (1, 0.32) | (<) 8307 (0.56, 0.74) | (>) 6171 (0.87, 0.23) |
| 7.4 (0.44, 123.83) | 3.93 (1.45, 7.94) | 1.18 (0.45, 3.11) | |
| 0.77 ( 0.63, 0.92)* | 0.66 (0.55, 0.77)* | 0.66 (0.57, 0.76) | |
|
| |||
| CM and IL8 (pg/ml) | (>) 24 (1, 0.3) | (>) 32 (0.88, 0.44) | (>) 54 (0.61, 0.58) |
| 3.42 (0.38, 30.90) | 5.56 (1.81, 17.07) | 1.82 (0.88, 3.78) | |
| 0.71 ( 0.56, 0.86) | 0.63 ( 0.53, 0.73)* | 0.68 (0.59, 0.78) | |
|
| |||
| CM and MCP1 (pg/ml) | (<) 294 (0.86, 0.45) | (>) 205 (0.78, 0.51) | (<) 97 (0.31, 0.83) |
| 5.42 (0.62, 47.25) | 3.62 (1.43, 9.22) | 0.39 (0.15, 0.99) | |
| 0.75 ( 0.55, 0.96) | 0.62 ( 0.52, 0.72)* | 0.68 ( 0.59, 0.77) | |
|
| |||
| CM and IL6 (pg/ml) | (>) 241 (0.71, 0.59) | (>) 178 (0.78, 0.62) | (>) 1790 (0.15, 0.97) |
| 1.83 (0.38, 8.74) | 4.81 (1.96, 11.79) | 3.96 (0.81, 19.35) | |
| 0.67 ( 0.46, 0.89) | 0.68(0.58, 0.79)* | 0.70 ( 0.61, 0.79) | |
|
| |||
| CM and all significant cytokines |
|||
| APACHE II | 1.02 ( 0.92, 1.13) | ||
| ISS | 1.00 (0.97, 1.05) | ||
| sTNFR2 <8307 pg/ml | 4.40 (1.56, 12.42) | ||
| sIL1RA >5022 pg/ml | 3.37 (1.18, 9.57) | ||
| IL6 > 178 pg/ml | 3.39 (1.11, 10.35) | ||
| IL8 > 32 pg/ml | 2.53 (0.69, 9.26) | ||
| MCP1 > 205 pg/ml | 1.48 (0.48, 4.61) | ||
| 0.83 (0.76, 0.91)** | |||
Optimal discrimination limits (ODL) for early cytokine level {within 12 hours of injury) associated with each outcome are reported with sensitivity and specificity for each model.
Odds ratios and area under receiver operator curve (AUC) with 95% confidence intervals (CI) are obtained for the effect of each cytokine as binary variable using ODL as cut-off in individual multivariate logistic regression models adjusted for clinical model.
Clinical model included composite APACHE II and injury severity scores in first 24 hours of injury and odds ratios are reported per unit change.
Implicates significant difference in AUC compared to clinical model at the significance level < 0.05.
Implicates significant difference in AUC compared to clinical model and all individual cytokine models at the significance level < 0.05.