The Value Of Mitochondrial DNA Level In Sepsis Disease Stratification And Prognosis Evaluation

Objective: Mitochondrial damage is closely related to the occurrence and development of sepsis,and mtDNA damage is one of the important mechanisms of mitochondrial damage.The purpose of this study was to explore the diagnostic value of plasma mtDNA level in the stratification of sepsis and the predictive value of mtDNA in the prognosis of sepsis.Methods: In a prospective study,65 children with sepsis who met the inclusion exclusion criteria in the PICU of the affiliated Children's Hospital of Chongqing Medical University from June 2019 to January 2020 were divided into sepsis group(n = 28)and septic shock group(n = 37)according to the severity of sepsis,and were divided into survival group(n= 46)and death group(n = 19)according to the outcome of 28 days after admission.The level of mtDNA in plasma of each group was measured by real-time fluorescence quantitative PCR.At the same time,the general clinical data and laboratory related indexes were collected,and the disease score(PCIS,PELOD-2,PRISM ?,pSOFA)was completed.Results :(1)The diagnostic value of plasma mtDNA level in thestratification of sepsis:(1)The level of plasma mtDNA in septic shock patients was significantly higher than that in sepsis group(P < 0.05).(2)The AUC,cutoff value and diagnostic value index of mtDNA level: the AUC of ND2-mtDNA was 0.789,and the diagnostic index in the stratification of sepsis was calculated with ND2-mtDNA 581.25pg/ml as cutoff value.The sensitivity,specificity,positive predictive value and prediction accuracy were 100%,67.9%,0.804 and 87.8%,respectively.The AUC of cytB-mtDNA was 0.818,and the diagnostic index in the stratification of sepsis was calculated with cytB-mtDNA 500.55pg/ml as cutoff value.The sensitivity,specificity,positive predictive value and prediction accuracy were 97.3%,78.6%,0.860 and 90.3%,respectively.(2)The relationship between the plasma mtDNA level and the prognosis of sepsis:(1)the comparison of mtDNA between the death group and the survival group: the plasma mtDNA level in the death group was higher than that in the survival group,but the difference was not statistically significant(P > 0.05).(2)the correlation between plasma mtDNA and PCIS,PELOD-2,PRISM ? and pSOFA score: plasma mtDNA was negatively correlated with PCIS(P < 0.05),positively correlated with PELOD-2(P <0.05),but had no significant correlation with PRISM ? and pSOFA.Conclusion:The level of plasma mtDNA in septic shock group is significantly higher than that in septic group,which has a certain diagnostic value in the disease stratification of sepsis and can be used as one of thebiomarkers to evaluate the condition of sepsis.There was no significant difference in plasma mtDNA level between sepsis death group and survival group,but it was weakly correlated with PCIS score and PELOD-2 score,and had no correlation with PRISM ? and pSOFA score,so the value of mtDNA in predicting the prognosis of sepsis was limited.