| Background:Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.Organ dysfunction is determined by a sequential(sepsis-related)organ dysfunction assessment(SOFA)score of ≥2.With an in-hospital mortality rate of >10% for patients presenting with organ dysfunction and an incalculable economic burden of sepsis,the prevention,recognition,and treatment of sepsis remain a global health priority.The atypical clinical presentation of sepsis,which often involves multiple organs,requires that sepsis be viewed as a systemic disease.In recent years,a relatively rich clinical practice of organ support treatment for sepsis has been accumulated worldwide,however,the mortality rate of sepsis has not been significantly improved,the mechanism of sepsis progression from infection to multi-organ dysfunction is still unclear,and biological markers for early diagnosis have not been identified,and specific drugs for sepsis have not been developed.Studying the gold standard for sepsis diagnosis and proposing standardized treatment protocols for sepsis is currently a major challenge in the medical field.Infection-induced inflammatory responses play an important role in the pathology of sepsis.alpha-defensin alpha1(DEFA1),a cysteine-rich cationic short peptide,is a major member of the antimicrobial peptide family,abundant in cells and tissues involved in host defense against microbial infections,with anti-microbial activity against a wide range of pathogenic microorganisms,and plays an important role in the prevention and control of microbial.It plays an important role in the prevention and control of microbial infections.In one study,DEFA1 was identified in body fluids following inflammatory stimuli,and DEFA1 has broad-spectrum antibacterial effects against a variety of pathogens causing sepsis and inhibits potentially harmful pro-inflammatory responses.However,the relationship between DEFA1 and the pathogenesis and clinical relevance of sepsis is not well defined.Therefore,we explored the potential value of plasma DEFA1 levels as a diagnostic and prognostic indicator of sepsis in the present study.Methods:Plasma samples were collected from patients with sepsis who met the diagnostic criteria of sepsis3.0 and patients who met the diagnostic criteria of community-acquired pneumonia(CAP)in 2016 from the intensive care unit(ICU)of Huaihe Hospital of Henan University,and plasma samples from healthy adults in the health management center of the hospital were collected to establish a sample bank(samples were obtained from July 2016 to June 2019).And plasma samples from the sample bank were selected from healthy adults,patients with CAP,patients with sepsis-associated pneumonia(SAP),respiratory system infection causing sepsis(RIS),and patients with digestive system infection causing sepsis(DIS).Patients with sepsis due to different systemic infections were combined with patients with sepsis(Sepsis).Enzyme-linked immunosorbent assay(ELISA)was applied to detect the levels of DEFA1 in plasma of different subgroups,and continuous measures that conformed to a normal distribution were expressed using the mean ± standard deviation;variables that were not normally distributed were expressed using the median and interquartile spacing;Kruskal-Wallis ANOVA test was used,followed by Dunn’s test for multiple groups;using Spearman’s correlation(rs)analysis of DEFA1 with clinical indicators;Kaplan-Meier method was used to draw survival curves and obtain risk ratios(HR)by Cox regression;ROC curves and AUC values were used to evaluate the role of DEFA1 in predicting sepsis prognosis.Results:1.DEFA1 levels were not significantly elevated in CAP and SAP patients compared to healthy adults(P>0.05);DEFA1 levels were significantly elevated in RIS patients compared to both CAP and SAP patients(P<0.0001);DEFA1 levels were significantly elevated in DIS,RIS,and Sepsis patients compared to healthy adults(P<0.0001);DIS and RIS patients had significantly higher DEFA1 levels compared to those with RIS(P=0.0039).2.Significant increases in plasma DEFA1 levels were present in patients with sepsis in multi-organ failure,with no significant increase in plasma DEFA1 levels at a total SOFA score <11.3.Among the six key organs,elevated plasma DEFA1 concentrations in both DIS and RIS patients showed the strongest positive correlation with renal dysfunction,with correlation coefficients of0.56 and 0.37,respectively,but no significant relationship with hepatic dysfunction.4.In patients with Sepsis,plasma DEFA1 levels were significantly increased in those who developed septic shock compared with those who did not(P<0.0001);there was a significant difference in DEFA1 levels in those who died 30 days after the diagnosis of sepsis compared with those who survived.5.There was a significant difference in the risk of death occurring 30 days after diagnosis in Sepsis patients with different plasma DEFA1 levels(P<0.001).6.The AUC value for plasma DEFA1 levels in Sepsis patients to predict septic shock was 0.786(P<0.001);the AUC value to predict 30-day survival outcome after sepsis diagnosis was 0.680(P<0.001);and the AUC value to predict renal organ dysfunction was 0.728(P<0.001).Conclusions:1.Plasma DEFA1 level has certain significance in the clinical diagnosis of sepsis.2.Plasma DEFA1 level is a potential indicator of the severity and prognosis of sepsis patients.3.Plasma DEFA1 level may be helpful in assessing renal organ dysfunction in patients with sepsis,but it is of little significance for judging liver organ dysfunction. |
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