Objective
To investigate the clinical value of peripheral serum cell-free DNA/neutrophil extracellular traps (cf-DNA/NETs) level in diagnosis and severity assessment of sepsis patients.
Methods
Forty patients with sepsis and 40 patients with non-infectious systemic inflammatory response syndrome (nf-SIRS) were enrolled in this study. The cf-DNA/NETs level in serum of all subjects were measured. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic ability of the cf-DNA/NETs, white blood cell count (WBC), procalcitonin (PCT) and interleukin-6 (IL-6). The sepsis patients were stratified into a survival group and a death group according to the prognosis. Sequential organ failure (SOFA) score were recorded in the sepsis patients, and the correlations between SOFA and cf-DNA/NETs, PCT, WBC, IL-6 were analyzed.
Results
Compared with the nf-SIRS group, cf-DNA/NETs and PCT levels were significantly higher in the sepsis group (both P<0.05). WBC and IL-6 showed no significant differences between the two groups (bothP>0.05). The area under the ROC curve (AUC) of cf-DNA/NETs was 0.884 for diagnosis of sepsis, and it was higher than the AUC of PCT (0.803). The cf-DNA/NETs showed better sensitivity (81.2% and 79.2%) and specificity (81.0% and 82.4%) than PCT. cf-DNA/NETs and PCT were significantly higher in the death group than those in the survival group. Bivariate collection analysis revealed positive correlations between SOFA score and the two biomarkers of cf-DNA/NETs and PCT (r1=0.573, r2=0.518; both P<0.01).
Conclusions
cf-DNA/NETs and PCT have certain value in early diagnosis of sepsis, and cf-DNA/NETs shows better diagnostic value in distinguishing sepsis from nf-SIRS than PCT. cf-DNA/NETs can be used as a routine monitoring index to help assess disease severity in sepsis.
Objective To analyze the expression changes of peripheral blood triggering receptor expressed on myeloid cells-1 (TREM-1) during the progression of sepsis, and to explore the utility of soluble TREM-1 (sTREM-1) and membrane-bound TREM-1 on myeloid cells in disease stratification of sepsis. Methods Sepsis patients, septic shock patients, and healthy controls were enrolled from West China Hospital of Sichuan University between June to December 2022. Membrane-bound TREM-1 expression on peripheral blood myeloid cells was detected by flow cytometry, and serum sTREM-1 levels were measured by enzyme-linked immunosorbent assay. The diagnostic performance of TREM-1-related parameters for discriminating sepsis from septic shock was evaluated by receiver operating characteristic curves. Results A total of 72 samples were collected. Among them, there were 10 healthy controls, 28 sepsis patients, and 34 septic shock patients. Peripheral blood sTREM-1, TREM-1+ granulocytes, and TREM-1+ monocytes showed significant differences among the sepsis, septic shock, and healthy control groups (P<0.05). For discriminating sepsis from septic shock, sTREM-1 yielded a sensitivity of 62.1% and a specificity of 88.9%; TREM-1+ granulocytes had a sensitivity of 65.5% and a specificity of 77.8%; and TREM-1+ monocytes had a sensitivity of 65.5% and a specificity of 66.7%. The combined model of the three indicators generated a predicted probability with an area under the curve of 0.881 [95% confidence interval (0.785, 0.978)], a sensitivity of 93.1%, and a specificity of 66.7%. Conclusions The expression of membrane-bound TREM-1 on peripheral blood granulocytes and monocytes, as well as serum sTREM-1, differs during sepsis progression and demonstrates auxiliary value in identifying disease stratification of sepsis. These parameters may serve as laboratory indicators for assessing the severity of sepsis.
