| Object:To evaluate the sensitivity and specificity of miRNA-223-3p for prediction and prognostic risk factors in patients with sepsis secondary to pneumonia by using Sepsis 3.0 diagnostic criteria as the golden standard.Methods:From January 2016 to August 2017,a total of 70 patients with sepsis secondary to pneumonia,52 patients with pneumonia and 21 healthy control were involved.Blood samples were collected from all subjects.After centrifugation,plasma samples were collected for cryopreservation at-80 ? fridge.Testing miRNA-150-5p ?miRNA-25-3p?miRNA-122-5p?mi RNA-223-3p expression levels in plasma of 70 patients by fluorescence quantitative PCR.The general information,SOFA score,final prognosis,ICU hospitalization days,etiology,etc were recorded.The specificity and sensitivity of miRNA in the prediction of sepsis was calculated by the area under the ROC(Receiver Operating Characteristic)curve.Using binary logistic regression analysis to evaluate the prognostic risk factors of sepsis secondary to pneumonia.Analysing the relationship between mi RNAs(including mi RNA-150-5p,miRNA-25-3p,miRNA-122-5p,and miRNA-223-3p)and the pathogenic microorganism in patients with sepsis secondary to pneumonia.Results:1.The area under ROC curve(AUC)for the prediction of sepsis secondary to pneumonia of PCT,CRP,APACHE II scores and combination of the three was 0.791,0.770,0.924,0.943,respectively.The area under ROC curve(AUC)for the prediction of septic shock secondary to pneumonia of PCT,CRP,APACHE II and combination of the three was 0.736,0.718,0.898,0.899,respectively.2.In 70 patients with sepsis secondary to pneumonia,65 cases of eligible samples were found to have pathogenic bacteria,and 5 cases were not clear.A total of 87 strains of pathogens were cultured from the lower respiratory tract secretions in the case group,including 43 strains(49.43%)of gram-negative bacilli,10 strains(11.49%)of gram-positive cocci and 19 strains(21.84%)of virus,12 strains(13.79%)of fungi,3 strains(3.45%)of mycoplasma.3.There were no significant difference in ?CT and relative expression levels of miRNA-150-5p?mi RNA-25-3p?mi RNA-122-5p in pneumonia,sepsis and healthy control groups.?CT levels of miRNA-223-3p in pneumonia,sepsis and healthy control groups were 2.39 ± 1.36,1.44 ± 1.43,and 4.58 ± 0.91,respectively,which were significantly different(p = 0.000).The relative expression levels of miRNA-223-3p in the three groups were 0.189(0.107,0.367),0.361(0.221,0.735),and 0.044(0.022,0.061),which were significantly different(p = 0.000).4.The AUC of the ROC of mi RNA-223-3p for the prediction of sepsis secondary to pneumonia was 0.964.At a cut-off value of 2.759,miRNA-223-3p yielded a sensitivity of 82.9% and a specificity of 100%.5.The ?CT of miRNA-150-5p in plasma of bacteria group,virus group and fungi group was 5.090 ±1.625,5.905±2.560,6.451±1.076,respectively.F=1.121,P=0.339.The relative expression levels of miRNA-150-5p was 0.031(0.013,0.064),0.023(0.006,0.082),0.013(0.005,0.021),respectively.?2=2.144,P=0.342.The ?CT of miRNA-25-3p in plasma of bacteria group,virus group and fungi group was-2.995±1.843,-3.434±3.254,-0.576±1.905,respectively.F=2.107,P=0.139.The relative expression levels of miRNA-25-3p was 8.862(3.253,18.438),23.093(1.685,87.770),0.843(0.583,4.743),respectively.?2=3.351,P=0.187.The ?CT of miRNA-122-5p in plasma of bacteria group,virus group and fungi group was 5.096±1.826,4.932±3.621,7.031±2.134,respectively.F=1.199,P=0.315.The relative expression levels of miRNA-122-5p was 0.034(0.012,0.087),0.039(0.010,0.450),0.014(0.001,0.023),respectively.?2=2.077,P=0.354.The ?CT of mi RNA-223-3p in plasma of bacteria group,virus group and fungi group was 2.434±1.417,2.638±2.533,2.530±0.349,respectively.F=0.034,P=0.967.The relative expression levels of miRNA-223-3p was 0.190(0.088,0.344),0.145(0.040,1.267),0.152(0.149,0.206),respectively.?2=0.245,P=0.885.6.Compared with survival group in sepsis secondary to pneumonia,the age(69.89±15.16 years),SOFA scores>5,SOFA scores of oxygenation index >3,disturbance of consciousness(71.1%),APACHE II scores >13 are higher than the non-survival group[58.63±21.27years?4.72±1.85?3(2,3)?37.5%?9.56±5.02](P<0.05).SOFA scores of oxygenation index>3 and APACHE II scores >13 are independent prognostic factors in patients with sepsis secondary to pneumonia.Conclusion:1.PCT,CRP and APACHE II score have certain values to the prediction of sepsis secondary to penumonia by Sepsis 3.0.The accuracy of APACHE II score is higher than that of PCT and CRP.2.The pathogens of sepsis secondary to penumonia in RICU of the People' Hospital of Zhengzhou University are mainly in gram-negative bacilli,followed by gram-positive cocci and virus.3.MiRNA-150-5p,miRNA-25-3p,miRNA-122-5p and miRNA-223-3p in plasma can not be used to distinguish pathogenic microorganism from patients with sepsis secondary to penumonia.4.MiRNA-223-3p expression was up-regulated in patients with sepsis secondary to pneumonia,and it has certain potential in predicting sepsis secondary to pneumonia.5.SOFA scores of oxygenation index>3 and APACHE II scores >13 are independent risk factors of sepsis secondary to pneumonia. |
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