Application Of Early Response Gene 3(IER3) In Early Warning Diagnosis Of Traumatic Sepsis

Trauma is a global public health problem.With the improvement of the treatment system and the development of pre-hospital emergency technology,the immediate mortality rate in the early stage of trauma has decreased significantly,but the complications of post-traumatic such as sepsis are still seriously threaten the prognosis of patients.The pathogenesis of sepsis is complex and involves many aspects.Its pathogenesis has the characteristics of cascade reactions,with dangerous attacks and rapid development.In recent years,a variety of plasma biomarkers have been used for the early diagnosis of sepsis,but they are controversial due to their low specificity and sensitivity.Therefore,omics analysis is used to find sensitive and effective biomarkers for the early diagnosis of severe trauma sepsis.It is of great significance.The immediate early response-3(IER3)is a glycosylated protein molecule that is induced by stress.It is rapidly induced and expressed in large quantities under the stimulation of cytokines,radiation exposure,virus infection,growth factors and other internal and external pressures of different cells.IER3 plays an important role in the regulation of proliferation,differentiation and apoptosis.It can positively and negatively regulate apoptosis.It is highly expressed in a variety of cancers and participates in the occurrence and development of tumors.IER3 also plays a vital role in regulating inflammation and ROS dynamic balance under stress.At present,studies have confirmed that the excessive production of ROS by tissue infiltrating immune cells plays a key role in the etiology of sepsis,suggesting IER3 It plays an important role in the occurrence and development of sepsis.Based on the above research,this study intends to explore whether severe trauma peripheral plasma IER3 can be used as a biomarker for early warning of severe trauma sepsis.The specific content and results of this research are as below:1)According to the inclusion and exclusion criteria,the peripheral blood and clinical data of 404 patients with severe trauma who were admitted to the trauma surgery and intensive care unit of the Central Hospital of Chongqing University and the Army Military Medical University between July 2016 and December 2019 were collected.ELISA technology detects the level of plasma IER3.Analyze the relationship between plasma IER3 level and injury severity and infection,and use ROC analysis to compare the value of IER3,LAC,CRP and PCT in the early diagnosis of sepsis in severe trauma patients.The results are as follows: In different injuries,it was found that the plasma IER3 levels of the two groups were not significantly different.Through correlation analysis,the severity of injury(ISS)was not related to plasma IER3.Compared with the non-infected group,the plasma IER3 level of the infected group was significantly increased(P<0.0001),and the correlation analysis found that infection was significantly related to plasma IER3.Compared with traumatic non-sepsis,the expression of plasma IER3 in the sepsis group was increased,which was significant(P<0.0001).Through logistic regression analysis,after correction for age,gender,and ISS,plasma IER3 was associated with the occurrence of post-traumatic sepsis(OR=1.045,95%CI(1.026-1.064),P<0.0001).Through ROC analysis,the early warning value of plasma IER3 for severe traumatic sepsis AUC was 0.791.At the same time,LAC,CRP and PCT were analyzed,and it was found that the early warning value of plasma IER3 for post-traumatic sepsis was higher than that of LAC,CRP and PCT.2)The expression changes of IER3 in various tissues and cell models of sepsis animal models were detected by quantitative PCR.The results showed that IER3 m RNA in the liver,kidney,spleen and lungs of mice following the progress of sepsis was significantly increased(P<0.05).The plasma IER3 level of mice was detected by ELISA experiment,and compared with the control group,its level was significantly increased(P<0.05).In the immune cell inflammation model,the level of IER3 m RNA was also significantly increased(P<0.05).In summary,the ROC curve analyzed the value of early-traumatic plasma IER3 for early warning of post-traumatic sepsis,and compared with traditional biomakers,its early warning ability is better than them.It indicates that the level of IER3 in peripheral plasma of trauma patients may be an important biomarker for early prediction of traumatic sepsis.In the mouse sepsis model,the expression level of IER3 in the liver,spleen,lung,kidney and other major organs and the level of plasma IER3 were significantly increased,suggesting that IER3 may be involved in the regulation of the occurrence and development of sepsis organ dysfunction.