Clinical Value Of Serum Hepcidin In Diagnosis And Prognosis Evaluation Of Sepsis

Objective:To investigate the clinical value of serum hepcidin for diagnosis and prognosis evaluation of sepsis,and to explore its potential mechanism.Methods:（1）Clinical data of 84 patients with sepsis,admitted in the ICU of the First Affiliated Hospital of Dali University from Sep.2019 to Sep.2020,were retrospectively analyzed.Another 50 sex-and age-matched non-septic patients admitted to ICU in the same period were selected as the ICU control group.50 healthy subjects admitted to hospital during the same period were enrolled as the health control group.（2）According to the prognosis at 28 d,84 sepsis patients were divided into survival group（n=50）and non-survival group（n=34）.Serum hepcidin levels were compared between the two groups.Correlation analysis between serum hepcidin levels and erythrocytes,hemoglobin,platelet,creatinine,urea nitrogen,CRP,PCT,SOFA scores,serum iron,ferritin,transferrin saturation,total iron binding capacity,IL-27,IL-33,IL-8,Eotaxin were performed.（3）The receiver operating characteristic curves（ROC）were plotted to evaluate the effect of serum hepcidin on the diagnosis and prognosis of sepsis.（4）Kaplan-Meier survival analysis was performed to compare the survival rate between patients with different serum hepcidin levels.（5）Cox proportional hazards regression model was used to estimate the 28-day mortality of each differential indicator for the patients with sepsis.Results:（1）The serum hepcidin levels were much higher in septic patients than in the health controls [（60.90±33.31）ng/m L vs.（23.13±6.49）ng/m L].Compared with ICU controls,serum hepcidin in septic patients were significantly increased [（60.90±33.31）ng/m L vs.（32.23±9.92）ng/m L].（2）Compared with survived septic patients,a significantly increased serum hepcidin level was observed in died septic patients [（82.21±44.14）ng/m L vs.（49.06±16.47）ng/m L].（3）ROC analysis indicated that the serum hepcidin exhibited the capability to identify individuals with sepsis,with an area under curve（AUC）of 0.85,and 0.74 in estimating the prognosis of sepsis patients.（4）Kaplan-Meier survival analysis showed that lower serum iron levels（≥70ng/m L）were correlated with poor 28-day survival in septic patients（P=0.015）.（5）Correlation analysis suggested significant positive correlations between serum hepcidin levels and Eotaxin levels（r=0.67,P<0.001）,IL-27 levels（r=0.65,P<0.001）,IL-8 levels（r=0.62,P<0.001）,as well as IL-33 levels（r=0.44,P<0.001）.（6）Multivariate Cox regression model suggested that high level of serum hepcidin was an independent risk factor for 28-day mortality of septic patients（HR=1.02,P<0.001）.Conclusions:（1）Serum hepcidin has certain value for diagnosing sepsis.（2）Serum hepcidin has certain value for predicting the 28-day mortality among sepsis patients,the 28-day mortality is higher in sepsis patients with serum iron ≥70ng/m L.（3）The mechanisms of hepcidin in sepsis may be regulated by cytokines.