Exploring The Value Of New Biomarkers For Diagnosis And Prognosis Predicting Of Sepsis Patients By ITRAO

Objective: To screen and verify the serum and urine of collelation novel biomarkerswhich can be for early diagnosis, disease severity and prognosis evaluation of sepsis.Methods:156patients were enrolled within the first24h after onset of systemicinflammatory response syndrome (SIRS)(n=10), sepsis (n=20; survivors10,non-survivors10) from Mar2012to May2013in Emergency ICU (EICU),Respiratory ICU (RICU) and Surgical ICU (SICU) of Chinese People’s LiberationArmy (PLA) General Hospital. Their blood and urine samples were both collected.Serum and urine proteins were identified by isobaric tag for relative and absolutequantitation (iTRAQ) coupled with liquid chromatography-tandem mass spectrometry(LC-MS). Mass spectroscopy analysis was performed with the Mascot software and theInternational Protein Index. Bioinformatics analyses were performed using the hierarchycluster analysis, the STRING software, the Gene Ontology (GO), and the KyotoEncyclopedia of Genes and Genome (KEGG) database. The potential biomarkers of131patients with sepsis and25patients with SIRS in seum and urine specimens weremeasured by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA).And the corresponding time clinical data were also recorded, such as vital sign,C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) counts, and soon.Results: With iTRAQ and LC-MS and bioinformatics analysis, we finally screened twodifferentially expressed proteins: alpha-1-acid glycoprotein (AGP) and vitamin Dbinding protein (VDBP), which were consistently expressed between serum and urine.The serum levels of AGP in sepsis were significantly higher than that in SIRS group,superior to CRP and PCT. And the serum AGP in the subgroups of sepsis hadstatistically significant difference. Urine levels of AGP had no obvious value in thediagnosis and prognosis evaluation of sepsis patients. Serum and urine VDBP cannoteffectively differentiate from sepsis from SIRS. Serum VDBP concentrationsignificantly lower as the illness severity grew worse, and also could predict the outcome of sepsis.Conclusion: Our study for the first time coupled iTRAQ with LC-MS on serum andurine specimens of sepsis patients to discover potential biomarkers for sepsis. SerumAGP could distinguish sepsis from SIRS, and could effectively assess severity of sepsis.Serum vitamin D binding protein can give an objective assessment on the severity andprognosis of patient with sepsis.