Objective To investigate the expression and clinical significance of serum Tenascin-C and Midkine in patients with sepsis complicated with myocardial injury(MI).Methods A total of 108 patients with sepsis(sepsis group) and 54 healthy volunteers(healthy control group) admitted to the Department of Emergency Medicine of Shaanxi Provincial People's Hospital from January 2019 to December 2024 were selected. Sepsis patients were divided into MI subgroup and non-MI subgroup according to whether they were complicated with MI. The levels of serum Tenascin-C and Midkine were detected by enzyme-linked immunosorbent assay; Multivariate unconditional Logistic regression analysis was used to analyze the factors of sepsis complicated with MI; ROC curve was used to analyze the predictive value of serum Tenascin-C, Midkine levels and other influencing indicators for sepsis complicated with MI. Results Compared with the healthy control group, the levels of serum Tenascin-C and Midkine in the sepsis group were increased( t=13.460,13.414, all P<0.001); the incidence of MI in patients with sepsis was 46.30 %(50/108); Compared with the non-MI subgroup, the levels of serum Tenascin-C and Midkine in the MI subgroup were increased( t=5.783,5.410, P<0.001). Sequential organ failure assessment(SOFA) score, creatine kinase isoenzyme(CK-MB), N-terminal pro-brain natriuretic peptide, Tenascin-C and Midkine were independent risk factors for sepsis complicated with MI[OR(95%CI)=1.169(1.015-1.348),1.685(1.247-2.277),1.003(1.001-1.004),1.342(1.134-1.589),1.616(1.194-2.186)]; the areas under the curve of Tenascin-C, Midkine and their combination in predicting sepsis complicated with MI were 0.780, 0.774 and 0.874, respectively, the combination of the two was superior to their respective predictive efficacy(Z/P=2.601/<0.001, 2.598/<0.001).Conclusion The increase of serum Tenascin-C and Midkine levels is related to sepsis complicated with MI, and the combination of the two has a high predictive value for sepsis complicated with MI.

Objective To analyze the correlation between serum methyltransferase-like protein 14(METTL14), receptor-interacting protein kinase 1(RIPK1) levels, disease severity, and prognosis in patients with sepsis-associated acute respiratory distress syndrome(S-ARDS). Methods A total of 182 S-ARDS patients admitted to the Emergency Department of Ningxia People's Hospital from January 2021 to August 2024 were selected as the S-ARDS group, along with 182 healthy volunteers matched at a 1∶1 ratio as the healthy control group. According to the severity of the disease(oxygenation index) and 28-day prognosis, S-ARDS patients were further divided into mild S-ARDS group(48 cases), moderate S-ARDS group(66 cases), severe S-ARDS group(68 cases), survival group, and death group. Serum METTL14 levels were measured by enzyme-linked immunosorbent assay. The correlation between serum METTL14, RIPK1 levels, and the oxygenation index of S-ARDS patients was analyzed using Pearson correlation analysis. Multivariate logistic regression, receiver operating characteristic(ROC) curve, and decision curve analysis(DCA) were used to assess the relationship, predictive value, and clinical benefit of serum METTL14 and RIPK1 levels for the prognosis of S-ARDS patients. Results Serum METTL14 and RIPK1 levels in the S-ARDS group were significantly higher than those in the healthy control group(t/P=20.742/<0.001,17.877/<0.001). Serum METTL14 and RIPK1 levels increased gradually with the severity of S-ARDS in the mild, moderate, and severe S-ARDS groups( F/P=310.610/<0.001,362.391/<0.001),and both were positively correlated with the oxygenation index( r/P=0.723/<0.001,0.742/<0.001). The 28-day mortality rate of 182 S-ARDS patients was 33.52%(61/182). Oxygenation index was an independent protective factor for mortality in S-ARDS patients, while mechanical ventilation time, sequential organ failure assessment(SOFA) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, METTL14, and RIPK1 were independent risk factors[OR(95%CI)=7.438(1.980-27.944),1.416(1.100-1.821),1.207(1.098-1.327),1.513(1.177-1.946),2.336(1.635-3.336),0.976(0.965-0.988)].The AUC of serum METTL14, RIPK1, and their combination in predicting mortality in S-ARDS patients was 0.771, 0.780, and 0.867, respectively, with a significantly larger AUC in the combined prediction model(Z/P=3.397/<0.001,3.198/<0.001). DCA showed that the combined prediction of METTL14 and RIPK1 had higher net benefit rates than the individual indicators within the threshold probability range of 0.20-0.95. Conclusion Elevated serum METTL14 and RIPK1 levels are closely associated with disease severity and mortality in S-ARDS patients. The combined prediction model based on serum METTL14 and RIPK1 levels provides higher predictive value and net clinical benefit for S-ARDS patient mortality.

Objective To investigate the effect of different timing of continuous renal replacement therapy(CRRT) combined with continuous venous haemofiltration(CVVH) on serum inflammatory factors in patients with sepsis-related acute kidney injury. Methods Patients with sepsis-related acute kidney injury( n=152) admitted to the Blood Purification Center of the Department of Nephrology, the First Affiliated Hospital of Air Force Military Medical University from February 2022 to August 2024 were selected. According to the Global Kidney Disease Prognostic Organization(KDIGO) grading criteria, patients with acute kidney injury grade 1 and 2 who initiated CRRT and CVVH were divided into early group( n=95), and patients with acute kidney injury grade 3 who initiated CRRT and CVVH were divided into late group( n=57). The general data and survival time of patients in the two groups were recorded, and the efficacy indexes, inflammatory factor indexes, renal function indexes and coagulation function indexes of the two groups were compared, and the 90-day survival rate of the two groups was analyzed by using the Kaplan-Meier survival curve. Results After treatment, the urine volume recovery time and mechanical ventilation time of the early group were significantly lower than those of patients in the late group(t/P=5.851/<0.001, 7.871/<0.001); and the early group's levels of TNF-α, PCT, IL-6, CRP, IFN-γ and VCAM-1 were significantly lower than the late group's( t/P=12.301/<0.001, 8.974/<0.001, 7.295/<0.001, 5.065/<0.001, 5.821/<0.001, 7.830/<0.001); the early group's levels of BUN, SCr, NGAL, and KIM-1 were significantly lower than the late group's(t/P=9.641/<0.001, 9.106/<0.001, 13.046/<0.001, 6.214/<0.001); the early group's PT and APTT were significantly longer than the late group's( t/P=6.186/<0.001, 5.867/<0.001); and the early group's levels of D-dimer and FIB were significantly lower than the late group's( t/P=12.407/<0.001, 12.950/<0.001); the difference in the survival rate between the early group and the late group was not statistically significant according to the Log-rank test( χ2=1.732, P=0.188). Conclusion Early CRRT combined with CVVH is effective in treating patients with sepsis-associated acute kidney injury, decreasing the level of inflammatory factors and improving renal and coagulation function, but it has no significant effect on ICU length of stay and survival time.

Objective To investigate the relationship between serum long non coding RNA colorectal neoplasia differentially expressed gene(lncRNA CRNDE) and silencing information regulator 1(SIRT1) levels and the stage of AKI and prognosis within 28 days in patients with sepsis acute kidney injury(AKI).Methods From February 2021 to July 2024, 102 patients with sepsis AKI admitted to the Department of Critical Care Medicine, 3201 Hospital Affiliated to Xi 'an Jiaotong University School of Medicine were selected as the sepsis AKI group, 93 patients with simple sepsis as the sepsis group, another 102 patients who underwent health checkups in hospitals during the same period were selected as the healthy control group. According to the AKI staging criteria, the patients with sepsis AKI group were divided into: 23 cases AKI stage Ⅰ, 43 cases AKI stage Ⅱ and 36 cases AKI stage Ⅲ. According to the 28-day survival of patients with sepsis AKI, they were divided into survival subgroup 81 cases(survived within 28 days) and death subgroup 21 cases(died within 28 days). The clinical data of the subjects at admission were collected and the serum kidney injury indicators [cystatin C(Cys-C), creatinine(SCr), blood urea nitrogen(BUN), neutrophil-gelatinase-associated lipid carrier protein(NGAL), kidney injury molecule-1(KIM-1)]were detected. Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and sequential organ failure assessment(SOFA) score at admission were performed in sepsis AKI group and sepsis group. Serum lncRNA CRNDE and SIRT1 levels were detected by fluorescence quantitative PCR and enzyme-linked immunosorbent assay, respectively. The correlation of serum lncRNA CRNDE and SIRT1 levels with APACHE Ⅱ score, SOFA score and kidney injury indicators in patients with sepsis AKI was analyzed by Pearson method. Cox regression analysis was performed to analyze the influencing factors of death within 28 days in patients with sepsis AKI. Receiver operating characteristic(ROC) curve was used to evaluate the value of serum lncRNA CRNDE and SIRT1 levels in predicting death within 28 days in patients with sepsis AKI. Results Compared with healthy control group, heart rate and Cys-C in sepsis group were significantly increased( t/P=15.929/<0.001, 9.070/<0.001), and heart rate, Cys-C, SCr, BUN, NGAL and KIM-1 in sepsis AKI group were significantly increased( t/P=16.577/<0.001, 58.367/<0.001, 74.060/<0.001, 31.215/<0.001, 37.756/<0.001, 30.060/<0.001); compared with sepsis group, APACHE Ⅱ score, SOFA score, Cys-C, SCr, BUN, NGAL and KIM-1 in sepsis AKI group were significantly increased( t/P=14.009/<0.001, 14.997/<0.001, 54.223/<0.001, 68.920/<0.001, 29.031/<0.001, 34.946/<0.001, 28.389/<0.001). Serum lncRNA CRNDE levels in healthy control group, sepsis group and sepsis AKI group were increased successively, and serum SIRT1 levels were decreased successively( F/P=2 222.437/<0.001, 257.866/<0.001). Serum lncRNA CRNDE levels in patients with AKI stage Ⅰ, AKI stage Ⅱ and AKI stage Ⅲ were increased successively, while SIRT1 levels were decreased successively(F/P=126.602/<0.001, 117.367/<0.001). Serum lncRNA CRNDE levels in patients with sepsis AKI was negatively correlated with SIRT1( r/P=-0.605/<0.001), and positively correlated with APACHE Ⅱ score, SOFA score, Cys-C, SCr, BUN, NGAL and KIM-1( r/P=0.542/<0.001, 0.503/<0.001, 0.489/<0.001, 0.471/<0.001, 0.425/<0.001, 0.413/<0.001, 0.538/<0.001); serum SIRT1 levels was negatively correlated with APACHE Ⅱ score, SOFA score, Cys-C, SCr, BUN, NGAL and KIM-1( r/P=-0.526/<0.001,-0.514/<0.001,-0.505/<0.001,-0.493/<0.001,-0.
481/<0.001,-0.429/<0.001,-0.519/<0.001). Compared with survival subgroup, APACHE Ⅱ score, SOFA score, Cys-C, SCr, BUN, NGAL, KIM-1 and lncRNA CRNDE in death subgroup were significantly increased, while SIRT1 was significantly decreased( t/P=7.356/<0.001, 12.000/<0.001, 33.798/<0.001, 7.028/<0.001, 8.183/<0.001, 5.065/<0.001, 8.820/<0.001, 19.668/<0.001, 10.988/<0.001). High APACHE Ⅱ score, high SOFA score, high Cys-C, high SCr, high BUN, high NGAL, high KIM-1 and high lncRNA CRNDE were all independent risk factors for death within 28 days in patients with sepsis AKI, and high SIRT1 was independent protective factor[OR(95%CI)=1.998(1.147-3.479), 1.868(1.142-3.056), 2.016(1.115-3.643), 1.685(1.143-2.485), 1.960(1.208-3.181), 2.237(1.176-4.254), 2.113(1.209-3.694), 2.601(1.336-5.065), 0.442(0.279-0.700)]. The area under curve(AUC) of serum lncRNA CRNDE, SIRT1 and their combination in predicting death within 28 days in patients with sepsis AKI were 0.787, 0.816 and 0.905, respectively, the AUC predicted by the combination of the two was significantly higher than that predicted by lncRNA CRNDE and SIRT1 alone( Z=1.758, 1.431, all P<0.001). Conclusion Serum lncRNA CRNDE expression was high and SIRT1 expression was low in patients with sepsis AKI, both of which were correlated with the stage of AKI, kidney injury indicators and prognosis within 28 days, and could help predict death within 28 days.