Correlation Between Interleukin-18 And Sepsis Diagnosis And Prognosis

backgroundSepsis is a critical illness commonly seen in intensive care units(ICUs)with high mortality rates,making it the main cause of death in ICUs and a significant burden on healthcare systems worldwide,including both developed and developing countries.Although the diagnosis of sepsis has been optimized through various diagnostic criteria,including Sepsis 3.0,it remains challenging.The complexity of diagnosis poses a significant obstacle to clinical work,making it difficult to provide patients with early and effective treatment,which is also one of the important reasons for poor prognosis.This study aims to investigate whether the inflammatory cytokine interleukin-18(IL-18)can be used for early diagnosis of sepsis and whether different levels of IL-18 in patient serum are related to patient prognosis.This study will conduct a prospective study on hospitalized infected patients admitted to the Respiratory Intensive Care Unit and ICU at the Eighth Affiliated Hospital of Guangzhou Medical University and the Guangzhou Red Cross Hospital.The study will investigate the relationship between IL-18 and the early diagnosis and prognostic evaluation of sepsis,providing new diagnostic and therapeutic strategies for clinical practice.PurposePart I: Serum IL-18 concentration and early diagnosis of sepsisObjective: Sepsis is defined as a life-threatening organ dysfunction syndrome caused by the host’s malregulated response to infection,and early diagnosis isparticularly difficult.This study aimed to investigate the clinical significance of serum IL-18,IL-6,PCT and CRP levels in early diagnosis of sepsis.Prospective studies were conducted to explore the role of IL-18,IL-6,PCT,CRP and other inflammatory factors in the diagnosis of sepsis.Part II: Serum IL-18 concentration and sepsis prognosis Objective: Sepsis often has a poor prognosis and a high mortality rate.This prospective study was conducted to investigate the role of IL-18,IL-6,PCT,CRP and other inflammatory factors in evaluating the prognosis of sepsis,so as to provide clinical guidance for the intensity of treatment.Through this study,explore the early diagnosis and prognosis of sepsis patients,to provide a theoretical basis for the diagnosis and treatment strategy of sepsis.Study Design1.Part I:1.1 Subjects: Inpatients admitted to the respiratory Intensive Care Department and intensive Care Unit of the Eighth Affiliated Hospital of Guangzhou Medical University and Guangzhou Red Cross Hospital from October 2021 to March 2023.Fifty-three patients with sepsis were selected as the case group,and 18 patients with non-sepsis were selected as the control group.1.2 Methods: Baseline data of patients were recorded,including age,gender and other baseline and basic biochemical data.The LEGENDplex assay was used to detect the levels of serum inflammatory factors such as IL-18,IL-6,PCT and CRP within 24 hours after admission.The value of serum inflammatory factors such as IL-18,IL-6,PCT and CRP in the early diagnosis of sepsis was evaluated by ROC.1.3 Data analysis: SPSS 26.00 software was used for statistical analysis of the data,including receiver operating characteristic curve(ROC)and multi-factor regression analysis.2.Part Two2.1 Subjects: Patients diagnosed with sepsis in the intensive care unit(ICU)of Eighth Affiliated Hospital of Guangzhou Medical University and Guangzhou Red Cross Hospital from October 2021 to March 2023.2.2 Methods: Serum samples of patients diagnosed with sepsis were collected within 24 hours after admission to intensive care unit(ICU).IL-18,IL-6,PCT and CRP concentrations in serum of patients were detected,and the correlation with the prognosis of patients with sepsis was investigated.According to the observation end point,they were divided into survival group and death group for comparative analysis between groups.2.3 Observation indicators and observation endpoint: Baseline data of patients were recorded,including age,gender and other baseline and basic biochemical data,such as the concentration level of BNP,MYO,troponin,AST,Cr,and whole blood white blood cell count.Serum IL-18 and CRP concentration,serum PCT and serum IL-6 concentration were recorded.Endpoint: Death within 28 years.2.4 Data analysis: SPSS 26.00 software was used for statistical analysis of the data,including receiver operating characteristic curve(ROC)and multi-factor regression analysis and cox survival analysis.Result1.In the ROC curve of diagnostic analysis,the area under the IL-18 curve(AUC)was 0.828,the optimal critical value for the diagnosis of sepsis was 197.005 Pg/ml,the 95% confidence interval(0.69-0.95),the sensitivity for the diagnosis of sepsis was79.2%,and the specificity was 77.8%(Yoden index =0.57).The diagnostic efficacy was significantly higher than serum IL-6,PCT,CRP and other inflammatory factors.2.The serum IL-18 level in the death group(507.5 ± 456.8)was significantly higher than that in the survival group(213.3 ± 113.7).The long-term survival rate of patients with high serum IL-18 concentration(≥261.96pg/ml)was significantly lower than that of patients with low IL-18 concentration(< 261.96pg/ml).The hazard ratio(HR)in Cox survival analysis of sepsis patients with high and low serum IL-18 levels was 4.6038,the lower limit of 95% interval was 1.9421,the upper limit of 95% interval was 10.9132,and the P value was 0.0005.Conclusion1.Serum IL-18 has a high diagnostic value in the early diagnosis of sepsis,which can more accurately determine whether patients suffer from sepsis,and its diagnostic efficacy is higher than serum IL-6,PCT,CRP and other indicators.2.Serum IL-18 level is closely related to the severity and prognosis of sepsis patients.High serum IL-18 level is a risk factor for sepsis death.3.The combination of serum IL-18 level with IL-6,PCT,CRP and other indicators may further improve the accuracy of diagnosis and prognosis assessment of sepsis.