Objective: To investigate the early diagnosis and prognosis value of biomarker combination test in patients with sepsis-associated acute liver injury. Methods: The clinical data of 104 sepsis patients admitted to the Intensive Care Unit (ICU) of Baotou First Affiliated Hospital of Inner Mongolia University of Science and Technology from November 2019 to January 2022 were collected. Selected cases were divided into sepsis-associated acute liver injury group (n=42) and non-liver injury group (n=62) based on acute liver injury occurring or not when entering ICU. Patients with septic acute liver injury were divided into survival groups (n=16) and death groups (n=26) after 28 days of survival. The sera pentraxin-3 (PTX-3), c-reactive protein (CRP), procalcitonin (PCT), total bilirubin (TBIL), glutamic-oxal(o)acetic transaminase (AST), glutamate pyruvate transaminase (ALT), international normalized ratio (INR value), prothrombin time (PT), prothrombin activity (PTA), platelet (PLT) of the 104 patients were recorded within 6h after entering ICU, the worst score of acute physiology and chronic health assessment scale Ⅱ(APACHE Ⅱ) score and sequential organ failure assessment (SOFA) grade within 24 hours was recorded after entering the ICU. The 28 d prognosis of patients with sepsis-related acute liver injury was also recorded. The correlation of PTX-3 was analyzed using Spearman correlation coefficient. The receiver operating characteristic curve (ROC curve) was also drawn, and the area under the roc curve (AUC) was calculated. The diagnosis and prognosis value of individual detection and combined testing on sepsis-related acute liver injury were analyzed and evaluated. Results: The levels of serum PTX-3, CRP, PCT, TBIL, AST and ALT, INR value, PT, APACHE Ⅱ score and SOFA score were significantly higher in the sepsis-associated acute liver injury group than those in the non-liver injury group, PTA and PLT level were lower than that in the non-liver injury group (P＜0.05). The Spearman correlation analysis result showed that a significant positive correlation between PTX-3 level and APACHE Ⅱ score and SOFA score. The ROC curve analysis results showed that the diagnostic efficacy of TBIL level, INR value and PTX-3 level were similar for sepsis-associated acute liver injury, which were outperformed the other indicators. The combination testing of the three indicators was more effective (AUC=0.945), with the sensitivity of 85.7 % and the specificity of 95 %. The levels of serum PTX-3, CRP , PCT, TBIL, AST and ALT, INR value, PT, APACHE Ⅱ score and SOFA score in the death group were significantly higher than those in the survival group, but PTA and PLT level were lower than that in the survival group (P＜0.05). The ROC curve analysis results showed that the diagnostic efficacy of PTX-3 level was better for 28 d death of sepsis-associated acute liver injury than other indicators. AUC of combination of PTX-3 level and TBIL and INR value reached 0.913, with the sensitivity of 96 % and the specificity of 75 %. Conclusion: The PTX-3 level, TBIL level and INR value are helpful biomarkers for early diagnosis of sepsis-associated acute liver injury, which could obviously improve the early diagnostic value in patients with sepsis-associated acute liver injury. The diagnostic efficacy of PTX-3 level, TBIL level and INR value were similar for sepsis-associated acute liver injury. PTX-3 level is related to severity, and the highest prognostic value on 28 d death of sepsis-associated acute liver injury, and combination testing on PTX-3 level, TBIL level and INR value could improve the 28-day prognosis of patients with acute liver injury. Meanwhile, the reduction of PLT level may be independently correlated with sepsis-associated acute liver injury.
WU Di
,
CHEN Jiaying
,
GENG Lixia
. Clinical study of biomarker combination test in patients with sepsis-associated acute liver injury[J]. Journal of Baotou Medical College, 2023
, 39(2)
: 12
-19
.
DOI: 10.16833/j.cnki.jbmc.2023.02.003
[1] Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016[J]. Crit Care Med, 2017, 45(3): 486-552.
[2] Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations[J]. Am J Respir Crit Care Med, 2016, 193(3): 259-272.
[3] 范晶. 白介素-27在脓毒症相关性急性肝损伤中的作用和初步机制研究[D]. 重庆: 重庆医科大学, 2020.
[4] 黄伟. 《第三版脓毒症与感染性休克定义国际共识》解读[J]. 中国实用内科杂志, 2016, 36(11): 959-962.
[5] Pruinelli L, Westra BL, Yadav P, et al. Delay within the 3-hour surviving sepsis campaign guideline on mortality for patients with severe sepsis and septic shock[J]. Crit Care Med, 2018, 46(4): 500-505.
[6] 林慧, 梁琦强, 蔡旗旗, 等. 脓毒症相关性肝损伤的高危因素及临床特点分析[J]. 中华危重病急救医学, 2021, 33(2): 186-191.
[7] Kluge M, Tacke F. Liver impairment in critical illness and sepsis: the dawn of new biomarkers [J]. Ann Transl Med, 2019, 7(Suppl 8): S258.
[8] Jenniskens M, Langouche L, Vanwijngaerden YM, et al. Cholestatic liver (dys)function during sepsis and other critical illnesses[J]. Intensive Care Med, 2016, 42(1): 16-27.
[9] Wang DW, Yin YM, Yao YM. Advances in sepsis-associated liver dysfunction[J]. Burns Trauma, 2014, 2(3): 97-105.
[10] Wožnica EA, Inglot M, Wožnica RK, et al. Liver dysfunction in sepsis[J]. Adv Clin Exp Med, 2018, 27(4): 547-551.
[11] Vilahur G, Badimon L. Biological actions of pentraxins[J]. Vascul Pharmacol, 2015, 73: 38-44.
[12] Serrano I, Luque AN, Aran JM. Exploring the immunomodulatory moonlighting activities of acute phase proteins for tolerogenic dendritic cell generation[J]. Front Immunol, 2018, 9: 892.
[13] Staubli SM, Scháfer J, Rosenthal R, et al. The role of CRP and Pentraxin 3 in the prediction of systemic inflammatory response syndrome and death in acute pancreatitis[J]. Sci Rep, 2019, 9(1): 18340.
[14] Muller B, Peri G, Doni A, et al. Circulating levels of the long pentraxin PTX3 correlate with severity of infection in critically ill patients[J]. Crit Care Med, 2001, 29(7): 1404-1407.
[15] Ristagno G, Varpula T, Masson S, et al. Elevations of inflammatory markers PTX3 and sST2 after resuscitation from cardiac arrest are associated with multiple organ dysfunction syndrome and early death[J]. Clin Chem Lab Med, 2015, 53(11): 1847-1857.
[16] 石春霞, 陈倩, 王瑶, 等. 急性肝衰竭小鼠血清与组织中PTX3、HBP、PCT及IL-6、IL-1β、TNF-α的变化及诊断价值[J]. 医学研究杂志, 2020, 49(1): 28-33.
[17] 王军宇, 王宏伟, 刘温馨, 等. 降钙素原和血乳酸及病情严重程度评分对脓毒症患者预后的评估价值[J]. 中华危重病急救医学, 2019, 31(8): 938-941.
[18] Moseley RH. Sepsis and cholestasis[J]. Clin Liver Dis, 2004, 8(1): 83-94.
[19] Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the european society of intensive care medicine[C]. Intensive Care Med, 1996, 22(7): 707-710.
[20] Jensen JS, Peters L, Itenov TS, et al. Biomarker-assisted identification of sepsis-related acute liver impairment: a frequent and deadly condition in critically ill patients[J]. Clin Chem Lab Med, 2019, 57(9): 1422-1431.
[21] 仝珊, 卢彩兰, 李燕, 等. 脓毒症患者血脂水平与超敏C反应蛋白APACHEⅡ评分关系研究[J]. 山西医药杂志, 2014, 43(3): 250-252.
[22] Al Tehewy M, El Houssinie M, El Ezz NA, et al. Developing severity adjusted quality measures for intensive care units[J]. Int J Health Care Qual Assur, 2010, 23(3): 277-286.
[23] 凌萍, 杨勤, 陈建丽, 等. 脓毒症患儿内皮细胞损伤标记物水平变化及其与严重程度的关系[J]. 贵州医药, 2016, 40(5): 463-465.
[24] Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit[J]. J Coll Physicians Surg Pak, 2011, 21(1): 4-8.
