| Objectives Infectious diseases are a common and costly diseases.Serological markers are extensively used in the clinic for diagnosing.Human neutrophil lipocalin(HNL)is used as a novel biomarker for infections.However,only a few studies have focused on the usefulness of HNL.Grouping and detection of infectious diseases patients level of HNL,procalcitonin(PCT)and c-reactive protein(CRP).we evaluated the diagnosis performance of each biomarkers.Then compared the levels of HNL,PCT,and CRP in patients with different infection sites and bacteria.Besides,we further explore the potential for a more accurate method of diagnosing bacterial infection.Methods1.Hospital patients in Anhui provincial hospital of Anhui medical university with530 acute infections(344males and 186 females)and 67 healthy volunteers(43 males and 24 females)were included in the study.2.Additionally,CRP,HNL,and PCT levels were measured by established methods.3.The infection status of each patient was verified using microbiological,serological,and PCR testing.Comparing the subgroups which grouped based on the infection sites and bacteria.The statistical program SPSS18.0 was used for the data analyzing of all experimental groups and subgroups test.Results 1.The CV of HNL ELISA KIT is 3.5%.HNL level is significant different when storage in different temperature conditions(P<0.05).2.According to the statistics,level of HNL was 170.9(110.4-263.1)μg/L and HNL77.5(55.6-119.0)μg/L.In distinguishing bacterial and viral infections,area under the curve(AUC)analysis showed that,with a value of 0.89(95% CI,0.86–0.92),HNL was superior to CRP at 0.77(0.71–0.83)and PCT at 0.88(0.84–0.92).Upon further analysis of the ability of biomarkers to distinguish bacterial and viral infections,HNL,PCT and CRP were 0.81(0.76-0.86),0.64(0.88-0.70)and 0.73(0.88-0.79),respectively.Combining the HNL,PCT,and CRP markers to improve their diagnostic power.The AUC of HNL/PCT/CRP was 0.96(0.95-0.98,P <0.05)and 0.86(0.82-0.90),respectively,which were both higher than each single biomarker.3.Subgroups were divided basis on the infected site.The HNL levels of the bloodstream infection group,abdominal infection group,bacterial pneumonia group,soft tissue infection group,urinary tract infection group and healthy control group were 234.15(140.01-334.81)μg/L,239.225(168.98-331.70)μg/L,152.69(97.72-228.31)μg/L,123.7(90.60-172.18)μg/L,139.36(84.73-199.55)μg/L,respectively.For the diagnosis of bloodstream infection and abdominal infection,HNL had the highest diagnostic performances,with an AUC of 0.94(0.89-0.99)and0.96(0.93-0.99),respectively.The diagnostic efficacy of soft tissue infection was lower,with an AUC of 0.82(0.74-0.91).4.For HNL and CRP,There was no difference between the Gram-positive bacteria(GPB)infection group and the Gram-negative bacteria(GNB)infection group(P>0.005).But the PCT level of GNB infection group was significant higher than GPB infection group(P = 0.0258).There was no statistical difference in HNL(P=0.3464),PCT(P=0.898)and CRP(P=0.0916)between each subgroup of bacteria.5.In patients with rheumatic disease,infection group HNL level is higher(P=0.0373),while no significant different is found between uninfected rheumatic group and healthy(P=0.1356).In tumor patients,the infected group is significant higher(P=0.0113),and no significant different between uninfected tumor patients and healthy(P=0.0699).In the leukemia patients,there is no significant different between infected patients and uninfected patients(P=0.7493).6.After 4 days of antibiotic treatment,CRP began to show a slowly downward trend,while HNL(P=0.0427)and PCT(P=0.0488)both decreased after 2 days of treatment.HNL levels decreased significantly in 55% of patients after 4 days of treatment,and 90% of patients were in the normal range after 6 days of treatment.At 6days of treatment,40% of patients PCT levels has not reduced to normal.Conclusions1.HNL kit was linearly CV of the test stable.The level of HNL in serum was higher than plasma.2.Compared with PCT and CRP,serum HNL had a higher diagnostic efficiency in the diagnosis of bacterial infection,and compared with single biomarker,The ombination of HNL,CRP,and PCT will improve the diagnosis performance markedly.3.HNL level was significantly higher not only in the bloodstream infection and abdominal infection groups,but also in the soft tissue infection and urinary tract infection groups than in the healthy control group,which was different from PCT.4.The HNL level was not related to the type of bacteria infected.It was significantly increased in both gram-positive and gram-negative patients.5.HNL can be used as an auxiliary diagnosis for concurrent infection in patients with rheumatic diseases and tumors,but not in patients with leukemia.6.After effective treatment with antibiotics,the HNL level of patients with bloodstream infection decreased faster,and the treatment effect could be timely evaluated... |
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