Objective To investigate the value of serum serum/glucocorticoid-regulated kinase 1(SGK1) and meteorin-like(Metrnl) levels in assessing the severity and prognosis of sepsis patients. Methods A total of 90 sepsis patients admitted to the Emergency Medicine Department of Yueyang Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, from January 2022 to May 2024 were enrolled as the observation group. Based on disease severity, patients were divided into the general sepsis subgroup(68 cases) and the septic shock subgroup(22 cases). According to the 28-day prognosis, they were further divided into the death subgroup(25 cases) and survival subgroup(65 cases). Additionally, 30 healthy volunteers from the hospital's health checkup program during the same period were included as the healthy control group. Serum SGK1 and Metrnl levels were measured by enzyme-linked immunosorbent assay. The correlation between serum SGK1, Metrnl levels, and disease severity in sepsis patients was analyzed using Pearson correlation. Multivariate logistic regression was used to determine the effect of serum SGK1 and Metrnl levels on sepsis prognosis. Receiver operating characteristic(ROC) curves were constructed to evaluate the predictive performance of serum SGK1 and Metrnl levels for sepsis mortality prognosis. Results Serum SGK1 levels in the observation group were lower than those in the healthy control group, while serum Metrnl levels were higher(t/P=8.394/<0.001, 10.994/<0.001). Serum SGK1 levels in the septic shock subgroup were lower than those in the general sepsis subgroup, while Metrnl levels were higher(t/P=4.444/<0.001, 4.493/<0.001). The severity of sepsis was negatively correlated with serum SGK1 levels and positively correlated with Metrnl levels(r/P=-0.677/<0.001, 0.685/<0.001). In the death subgroup, the proportions of septic shock and mechanical ventilation ≥3 days, Sequential Organ Failure Assessment(SOFA) scores, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores, and serum Metrnl levels were higher than in the survival subgroup. Conversely, the oxygenation index and serum SGK1 levels were lower(χ2/t/P=10.399/0.001, 7.123/0.008, 3.208/0.003, 4.234/<0.001, 4.634/<0.001, 4.156/<0.001, 4.578/<0.001). Multivariate logistic regression analysis showed that elevated serum Metrnl levels were an independent risk factor for sepsis mortality [OR(95%CI)=1.028(1.008-1.049)],while elevated serum SGK1 levels were an independent protective factor [OR(95%CI)=0.614(0.421-0.896)]. The area under the curve(AUC) for predicting sepsis mortality using serum SGK1, Metrnl levels, and their combination was 0.791, 0.783, and 0.886, respectively, with the combined AUC being significantly greater than either alone(Z/P=2.122/0.034,2.382/0.017). Conclusion Serum SGK1 levels decrease while Metrnl levels increase in sepsis patients, both of which are associated with greater disease severity and mortality. Combined detection of serum SGK1 and Metrnl levels has good predictive performance for the prognosis of sepsis patients.

Objective To investigate the expression and clinical significance of extracellular nicotinamide phosphoribosyl transferase(eNAMPT) and soluble death receptor 5(sDR5) in patients with sepsis-associated acute respiratory distress syndrome(SA-ARDS). Methods A total of 205 SA-ARDS patients admitted to the Emergency Department of West China Hospital, Sichuan University from January 2021 to July 2024 were selected as the SA-ARDS group, and 114 healthy volunteers from the hospital's health check-up center were selected as the healthy control group. Based on the severity of the disease, the SA-ARDS patients were divided into three subgroups: mild SA-ARDS(62 cases), moderate SA-ARDS(74 cases), and severe SA-ARDS(69 cases). According to the 28-day prognosis, they were further divided into the death subgroup(80 cases) and survival subgroup(125 cases). Serum eNAMPT and sDR5 levels were detected by enzyme-linked immunosorbent assay. Spearman correlation analysis was performed to assess the correlation between serum eNAMPT, sDR5 levels, and the oxygenation index in SA-ARDS patients. Multivariate unconditional logistic regression analysis was used to examine the relationship between serum eNAMPT, sDR5 levels, and mortality in SA-ARDS patients. The diagnostic performance of serum eNAMPT and sDR5 levels was evaluated by receiver operating characteristic(ROC) curve analysis. Results Compared with the healthy control group, serum eNAMPT and sDR5 levels in the SA-ARDS subgroups were significantly elevated(t/P=14.006/<0.001, 19.931/<0.001). Serum eNAMPT and sDR5 levels increased progressively in the mild, moderate, and severe SA-ARDS subgroups(F/P=97.467/<0.001, 157.287/<0.001). Serum eNAMPT and sDR5 levels were negatively correlated with the oxygenation index(r/P=-0.724/<0.001,-0.720/<0.001). Prolonged intensive care unit(ICU) stay, mechanical ventilation ≥ 3 days, high Sequential Organ Failure Assessment(SOFA) score, high Acute Physiology and Chronic Health Evaluation II(APACHE II) score, elevated eNAMPT and sDR5 levels were identified as independent risk factors for mortality in SA-ARDS patients, while high oxygenation index was an independent protective factor [OR(95%CI)=1.221(1.028-1.449),3.111(1.207-8.020),1.270(1.064-1.517),1.093(1.025-1.167),1.104(1.054-1.157),1.030(1.015-1.046),0.989(0.982-0.996)].The area under the curve(AUC) for serum eNAMPT, sDR5 levels, and their combined evaluation in predicting mortality in SA-ARDS patients were 0.794, 0.780, and 0.877, respectively, with the combined assessment being superior to the individual assessments of eNAMPT or sDR5(Z/P=2.150/0.032, 2.273/0.023). Conclusion Elevated serum eNAMPT and sDR5 levels in SA-ARDS patients are closely associated with the severity of the condition and mortality. The combined evaluation of serum eNAMPT and sDR5 levels has a higher efficacy in predicting mortality in SA-ARDS patients.

Objective To investigate the expression levels and clinical significance of serum C-terminal agrin fragment(CAF) and proenkephalin a 119-159(penKid) in patients with sepsis complicated with acute kidney injury(AKI). Met-hods A total of 109 patients with sepsis complicated with AKI admitted to the Department of Intensive Care Medicine, the Fourth Affiliated Hospital of Nanjing Medical University from March 2021 to March 2024 were selected as the AKI group. According to the AKI staging criteria, they were divided into stage Ⅰ(n=46), stage Ⅱ(n=35) and stage Ⅲ(n=28). All patients were treated with renal replacement therapy(CRRT). According to the estimated glomerular filtration rate(eGFR) at 28 days after treatment, they were divided into good prognosis subgroup(n=83) and poor prognosis subgroup(n=26); 109 patients with simple sepsis were randomly selected as sepsis group. Serum CAF and penKid levels were detected by enzyme-linked immunosorbent assay, serum creatinine(SCr), cystatin C(Cys-C) and estimated glomerular filtration rate(eGFR) were detected by automatic biochemical analyzer; Pearson product moment correlation or Spearman rank correlation was used to analyze the relationship between serum CAF, penKid and renal function index, AKI stage; logistic regression analysis was used to analyze the adverse prognostic factors in patients with sepsis complicated with AKI; the receiver operating characteristic(ROC) curve was used to evaluate the predictive value of serum CAF and penKid for poor prognosis.Results Compared with the sepsis group, the levels of serum CAF and penKid, SCr and Cys-C in the AKI group were increased, and the level of eGFR was decreased(t/P=15.363/<0.001,12.104/<0.001,18.038/<0.001,19.221/<0.001,20.776/<0.001).The levels of serum CAF and penKid in patients with stage Ⅰ, stage Ⅱ and stage Ⅲ increased in turn, the levels of SCr and Cys-C increased in turn, and the levels of eGFR decreased in turn, the differences were statistically significant(F/P=95.573/<0.001,49.832/<0.001,85.548/<0.001,79.249/<0.001,421.846/<0.001). Serum CAF and penKid were positively correlated with AKI stage, positively correlated with SCr and Cys-C, and negatively correlated with eGFR(CAF:rs/P=0.762/<0.001,0.703/<0.001,0.715/<0.001,-0.771/<0.001;penKid: rs/P=0.734/<0.001,0.668/<0.001,0.694/<0.001,-0.702/<0.001). Compared with the good prognosis subgroup, the proportion of AKI stage Ⅱ and stage Ⅲ,the levels of serum CAF and penKid in the poor prognosis subgroup were increased, and the levels of eGFR was decreased(χ2/t/P=10.085/0.007,18.446/<0.001,11.075/<0.001,15.252/<0.001).AKI stage Ⅱ and stage Ⅲ, elevated CAF, elevated penKid were independent risk factors for poor prognosis in patients with sepsis and AKI[OR(95%CI)=1.130(1.032-1.236),1.783(1.246-2.558),1.586(1.157-2.173),1.533(1.127-2.085)],elevated eGFR was a protective factor for poor prognosis[OR(95%CI)=0.671(0.483-0.933)];The AUC of serum CAF, penKid and their combination in predicting the poor prognosis of sepsis patients with AKI were 0.831,0.822 and 0.916, respectively. The combination of the two was superior to their respective predictive values(Z=1.624,1.826,P=0.032,0.025).Conclusion The expression of serum CAF and penKid is up-regulated in patients with sepsis complicated with AKI, and is closely related to the severity and prognosis of AKI. Early combined detection can assist clinical prediction of the risk of poor prognosis.

Objective To explore the changes and significance of serum heat shock protein 70(HSP70) and heme oxygenase-1(HO-1) in patients with sepsis-induced gastrointestinal dysfunction. Methods Ninety-eight patients with sepsis-induced gastrointestinal dysfunction in Emergency Center of the First Affiliated Hospital of Xi'an Jiaotong University from February 2021 to February 2024 were selected as the study group, and 94 patients with sepsis but without gastrointestinal dysfunction who received treatment during the same period were included in the control group. Serum HSP70 and HO-1 levels were determined by enzyme-linked immunosorbent assay. The correlation between serum HSP70 and HO-1 levels and disease severity was analyzed. The influence of serum HSP70 and HO-1 on gastrointestinal dysfunction was analyzed by multivariate Logistic regression analysis. The predictive value of serum HSP70 and HO-1 levels on gastrointestinal dysfunction in patients with sepsis was evaluated by receiver operating characteristic curve(ROC). Results Serum HSP70 level in the study group was higher while serum HO-1 level was lower compared to the control group(t=6.984, 7.404, P<0.001). Serum HSP70 level in grade Ⅲ-Ⅳ patients was higher than that in grade I-II patients while serum HO-1 level was lower(t=3.605, 2.148, P<0.05). Spearman rank correlation analysis suggested that serum HSP70 level was positively correlated with the degree of gastrointestinal dysfunction, and HO-1 level was negatively associated with gastrointestinal dysfunction degree(r=0.317,-0.243, P=0.002, 0.017). Multivariate Logistic regression analysis indicated that high serum HSP70 level was an independent risk factor for gastrointestinal dysfunction[OR(95%CI)=1.014(1.008-1.020)], and high serum HO-1 level was a protective factor[OR(95%CI)=0.991(0.987-0.995)]. The areas under the curves(AUCs) of serum HSP70 and HO-1 alone and in combination were 0.760, 0.733 and 0.914, and the AUC of HSP70 combined with HO-1 was better than that of HSP70 or HO-1 alone(Z=4.799, 5.822, P<0.001). Conclusion Serum HSP70 and HO-1 levels are important indicators affecting the occurrence of sepsis-induced gastrointestinal dysfunction. Early determination of the above two levels can provide predictive value for the risk of sepsis-induced gastrointestinal dysfunction.

Objective To explore the expression levels of myocardial infarction-associated transcription factor(MIAT) mRNA and glycated hemoglobin(HbA1c) in peripheral blood of patients with diabetes and central obesity and their predictive value for microvascular complications.Methods Two hundred and twelve patients with diabetes and central obesity admitted to our hospital from May 2021 to March 2023 were prospectively selected as the observation group, and 212 healthy people who underwent physical examination during the same period were selected as the healthy control group. Early morning fasting peripheral blood was collected from all study subjects, and their MIAT mRNA and HbA1cexpression levels were detected. The patients were followed up for 1 year and were divided into a complication group(n=86) and a no-complication group(n=126) according to whether they developed microvascular complications. The ROC curve was used to analyze the predictive value of patients' serum MIAT mRNA and HbA1clevels for microvascular complications. Results Compared to the healthy control group, the expression levels of MIAT mRNA and HbA1cwere increased in the observation group(t/P=28.299/<0.001,22.952/<0.001). Logistic regression results showed that age(OR=1.450, 95%CI 1.141-2.093, P=0.016), BMI(OR=1.325, 95%CI 1.059-1.799, P=0.037), disease duration(OR=2.137, 95%CI 1.430-2.786, P<0.001), Hyperlipidemia(OR=2.368, 95%CI 1.626-3.439, P<0.001), fasting blood glucose(OR=2.705, 95%CI 1.909-5.172, P<0.001), MIAT mRNA(OR=2.449, 95%CI 1.753-3.652, P<0.001), HbA1c(OR=1.934, 95%CI 1.329-2.646,P<0.001) are risk factors for microvascular complications. According to ROC curve analysis, the sensitivity and specificity of serum MIAT mRNA detection alone is 0.767 and 0.619, and the area under curve is 0.719. The sensitivity and specificity of HbA1cdetection alone are 0.640 and 0.802. The sensitivity of combined detection of serum MIAT mRNA and HbA1cis 0.744, the specificity is 0.810, and the area under curve is 0.825. Conclusion The expression levels of MIAT and HbA1cin peripheral blood of patients with diabetes mellitus and central obesity increased, and the combined detection of the two had a high predictive value for microvascular complications.