| Background:Sepsis is defined as a life-threatening organ dysfunction caused by the body's inflammatory response caused by infection[1].The incidence of sepsis continues to increase,and the number of morbidities and deaths remains high,which is an important cause of death for critical patients worldwide.Sepsis progresses rapidly,its pathogenesis is complex,and clinical manifestations are often related to multiple systems,which is a major problem in medical research.In sepsis,delays in diagnosis and treatment can cause multiple organ failure and lead to patient death.Therefore,early diagnosis of sepsis is essential.Early diagnosis and effective management of sepsis may reduce patient mortality and may also reduce unnecessary use of antibiotics[2].At present,the clinical diagnosis of sepsis lacks a gold standard.In the past,blood culture was regarded as one of the main methods of sepsis diagnosis,but it was later found that although blood culture diagnosis had certain value,it had a low positive rate and took a long time.Therefore,clinicians mostly diagnose sepsis based on non-specific clinical signs and other laboratory tests and experience[3].At present,many biomarkers for the diagnosis of sepsis are found,C-reactive protein(CRP),lipopolysaccharide binding protein(LBP),procalcitonin(PCT),positive Pentraxin 3(PTX3)and cytokines,but most of these biomarkers have limited sensitivity and specificity,so it is not yet possible to accurately diagnose and evaluate sepsis.Insulin-like growth factor binding protein-2(IGFBP-2)belongs to one of the members of the insulin-like growth factor family[4].In the plasma of normal healthy people,the average concentration of IGFBP-2 is about 150 ng / ml,which is mainly synthesized by the liver[5].The study found that plasma IGFBP-2 levels in patients with gastrointestinal infectious diseases increased by 1.7 times compared with the control group[6].In addition,plasma IGFBP-2 levels in patients with lupus nephritis(LN)increased and were positively correlated with the degree of renal impairment[7].However,there are few studies on the relationship between plasma IGFBP-2 and pneumonia and sepsis.Our previous quantitative protein profiling study found that plasma IGFBP-2 levels were related to changes in the condition of sepsis patients.In this study,we compared normal healthy people,community-acquired pneumonia(CAP),sepsis-associated Pneumonia(SAP),and Plasma IGFBP-2 levels in patients with sepsis with Pneumonia(SWP);and plasma IGFBP-2 levels in sepsis patients before and after dialysis to preliminarily explore the diagnostic value of IGFBP-2 in SWP and its relationship with renal function.Method:We collected plasma samples of sepsis patients who were admitted to the Department of Respiratory and Critical Care Medicine and RICU of the Huaihe Hospital of Henan University from 2016-07 to 2019-06 according to the Sepsis 3.0 standard,and selected SWP(ie:sepsis + pneumonia)patient plasma samples,SAP(ie: SOFA <2 + pneumonia whose condition deteriorated into sepsis or pneumonia improved from sepsis)patient plasma samples,at the same time according to 2016 CAP diagnostic criteria to collect CAP and normal medical plasma samples as controls.We used enzyme-linked immunosorbent assay(ELISA)to measure plasma IGFBP-2 levels in each group,combined with patient clinical data using SPSS 26.0 software,using single sample K-S test,spearman correlation analysis,two independent sample rank sum test,and two related sample rank,ect.Result:By ELISA we found:1.IGFBP-2 levels in plasma samples of CAP patients were significantly(p <0.05)higher than normal healthy people(The plasma samples of CAP patients were 27 cases,and their IGFBP-2 levels were 294.92 ± 67.53 ng / ml;The plasma samples of normal healthy people were 31 cases,and their IGFBP-2 levels were 153.53 ± 22.17 ng / ml).2.IGFBP-2 levels in plasma samples of SAP patients were significantly higher(p<0.05)than in CAP patients,and IGFBP-2 levels in plasma samples of SWP patients were significantly higher(p<0.01)than in SAP patients,and IGFBP-2 levels in plasma samples of SWP patients were significantly higher than in CAP patients(p<10-4)(The plasma samples of CAP patients were 29 cases,and their IGFBP-2 levels were 365.67 ± 85.43 ng / ml;The plasma samples of SAP patients were 86 cases,and their IGFBP-2 levels were 398.00 ± 26.98 ng / ml;The plasma samples of SWP patients were 339 cases,and their IGFBP-2 levels were 604.26 ± 29.25 ng / ml).3.Plasma IGFBP-2 level can distinguish SWP from SAP and CAP(AUC = 0.60,95% CI = 0.54-0.66,p<0.01 for SWP versus SAP;AUC = 0.72,95% CI = 0.61-0.82,p <10-4 for SWP versus CAP).4.Correlation analysis of IGFBP-2 levels in plasma samples of SWP patients with clinical test indicators,SOFA scores of various systems and total SOFA scores: plasma IGFBP-2 levels had the highest correlation with renal function(r = 0.43,p <10-15).5.From SAP(r = 0.27,p <0.05)to SWP(r = 0.39,p <10-12),as the disease progressed,the correlation between plasma IGFBP-2 levels and creatinine increased.However,there was no significant correlation between plasma IGFBP-2 levels and creatinine in CAP patients.6.IGFBP-2(p<0.05)and creatinine(p<0.01)levels in plasma samples of patients with sepsis with pneumonia with acute kidney injury(SWP-AKI)within 24 hours after dialysis Significantly decreased within 24 hours before dialysis.Conclusion:1.Elevated plasma IGFBP-2 levels are a common body reaction caused by infection.2.IGFBP-2 may be used as a biomarker for the diagnosis of SWP.3.Among the six organs and systems involved in the sepsis 3.0 diagnostic criteria,the level of plasma IGFBP-2 is most closely related to the renal function impairment in SWP patients.4.Hemodialysis may be used as a treatment method to remove part of plasma IGFBP-2. |
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