Objective To evaluate interleukin-27 ( IL-27 ) as a sepsis diagnostic biomarker in critically ill adults with sepsis. Methods A retrospetive study was conducted. A total of 176 systemic inflammatory response syndrome ( SIRS ) patients in Department of Critical Care Medicine of Xinxiang Medical College First Affiliated Hospital from March to November in 2014 were enrolled. The patients were divided into no sepsis group ( n=66 ), pulmonary originated sepsis group ( n=65 ), and non-pulmonary originated sepsis group ( n=45 ). Plasma IL-27 and procalcitonin ( PCT ) were determined with enzyme linked immunosorbent assay ( ELISA ). Receiver operating characteristic curve ( ROC ) and classification and regression tree methodology was used to evaluate diagnostic biomarker performance. Results The proportion of patients in pulmonary original sepsis group whose body temperature in line with SIRS criteria was significantly higher than no sepsis group ( 66.2%vs. 44.5%, P<0.05 ), and they were easy to suffer from tumor ( 44.6%vs. 22.7%, P<0.05 ). The proportion of patients in non-pulmonary originated sepsis group whose white blood cell count in line with SIRS criteria was significantly higher than no sepsis group ( 68.9%vs. 42.7%, P<0.05 ). It indicated that patients in pulmonary originated sepsis group and non-pulmonary originated sepsis group were more in line with SIRS criteria compared with no sepsis group. It was shown by ROC curve that IL-27 and PCT was not effective in discriminating sepsis among unselected patients showing symptoms and signs of SIRS. The area under the curve ( AUC ) was 0.59 [ 95%confidence interval ( 95%CI )=0.49-0.65 ] and 0.61 ( 95%CI=0.55-0.71 ). According to the further analysis from different infection sources, the highest AUC was 0.71 ( 95%CI=0.59-0.79 ) for IL-27 in patients with a non-pulmonary originated sepsis. A decision tree incorporating IL-27, PCT, and age had an AUC of 0.78 ( 95%CI = 0.71-0.87 ) in patients with a non-pulmonary originated sepsis, which was higher than IL-27 [ 0.71 ( 95%CI = 0.59-0.79 ) ] or PCT [ 0.65 ( 95%CI = 0.57-0.78 ) ]. Compared to that of pediatric cohort with sepsis, lower expression of IL-27 was found in adult patients. Conclusions IL-27 performed overall poorly as a sepsis diagnostic biomarker in adults. IL-27 may be a more reliable diagnostic biomarker for sepsis in children than in adults. The combination of IL-27 and PCT can reasonably estimate the risk of sepsis in subjects with a non-pulmonary originated sepsis.%目的：评估白细胞介素-27（IL-27）对成人脓毒症危重患者的诊断价值。方法采用回顾性研究方法，选择2014年3月至11月新乡医学院第一附属医院重症医学科176例全身炎症反应综合征（SIRS）患者，按入院诊断分为非脓毒症组（n＝66）、肺源性脓毒症组（n＝65）和非肺源性脓毒症组（n＝45）。采用酶联免疫吸附试验（ELISA）检测各组患者血清IL-27和降钙素原（PCT）水平；绘制受试者工作特征曲线（ROC）判断各指标的诊断价值，并构建分类回归树，分析各生物标志物的性能，判断潜在的预测变量。结果肺源性脓毒症患者体温符合SIRS标准的比例明显高于非脓毒症患者（66.2%比44.5%，P＜0.05），且更易引发肿瘤合并症（44.6%比22.7%，P＜0.05）；非肺源性脓毒症患者白细胞数符合SIRS标准的比例明显高于非脓毒症患者（68.9%比42.7%，P＜0.05），说明肺源性和非肺源性脓毒症患者较非脓毒症患者更加符合SIRS标准。ROC曲线显示， IL-27和PCT都不能从具备SIRS症状的脓毒症患者中诊断出脓毒症患者，ROC曲线下面积（AUC）分别为0.59〔95%可信区间（95%CI）＝0.49～0.65〕和0.61（95%CI＝0.55～0.71）；根据不同感染源进一步分析显示，IL-27在非肺源性脓毒症患者中的AUC最大，但仅为0.71（95%CI＝0.59～0.79）。在非肺源性脓毒症患者中，基于IL-27、PCT和年龄构建分类回归树的AUC为0.78（95%CI＝0.71～0.87），明显大于IL-27〔0.71（95%CI＝0.59～0.79）〕或PCT〔0.65（95%CI＝0.57～0.78）〕。与文献报道的脓毒症患儿比较，成人脓毒症患者IL-27水平较低。结论 IL-27作为脓毒症诊断的生物标志物，对病情变化的反应不敏感，其用于脓毒症患儿的诊断较成人更实用；而IL-27和PCT结合更适于确定非肺源性脓毒症成人患者由SIRS发展为脓毒症的风险。
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