Predictive value of serum NLRP3,PGE2,GDF-15 for the concurrent catheter related blood stream infection in patients with diabetic nephropathy undergoing hemodialysis

Ye Ting

Yang Cheng

Chen Fen

Yuan Qiaomeng

Department of Nephrology,Central Theater Hospital of the Chinese People's Liberation Army

Abstract:Objective To explore the predictive value of serum NOD-like receptor family pyrin domain containing 3(NLRP3), prostaglandin E2(PGE2), and growth differentiation factor 15(GDF-15) for concurrent catheter-related bloodstream infection(CRBSI) in patients with diabetic nephropathy(DN) undergoing hemodialysis. Methods From May 2020 to May2025, a total of 210 hemodialysis patients treated at the Central Theater Hospital were selected, including 98 patients with CRBSI(CRBSI group) and 112 patients without bloodstream infection(non-CRBSI group). General patient information was collected, and serum levels of NLRP3, PGE2, and GDF-15 were detected using ELISA kits. Relative risk analysis was used to evaluate the effects of different serum levels of NLRP3, PGE2, and GDF-15 on the occurrence of CRBSI. Pearson correlation analysis was performed to assess the correlations between serum NLRP3, PGE2, GDF-15 levels and IL-6, CRP, and TNF-α.ROC curve analysis was used to evaluate the predictive value of serum NLRP3, PGE2, and GDF-15 for the occurrence of CRBSI. Results A total of 113 pathogenic bacterial strains were isolated from patients in the CRBSI group, with Grampositive bacteria accounting for the highest proportion at 65.49%(74/113), followed by Gram-negative bacteria at 30.09%(34/113), and fungal infections accounting for the lowest proportion at 4.42%(5/113). Patients in the CRBSI group had significantly higher levels of NLRP3, PGE2, and GDF-15 than those in the non-CRBSI group(t/P = 8.141/<0.001, 9.287/<0.001,9.330/<0.001). WBC, IL-6, CRP, and TNF-α levels were also significantly higher in the CRBSI group than in the non-CRBSI group(t/P = 11.567/<0.001, 13.123/<0.001, 15.450/<0.001, 17.614/<0.001). Serum NLRP3, PGE2, and GDF-15 levels showed positive correlations with WBC, IL-6, CRP, and TNF-α(r values ranged from 0.487 to 0.513, all P<0.001). The probability of developing CRBSI in patients with high serum levels of NLRP3, PGE2, and GDF-15 was 3.597, 2.772, and 3.033 times higher than that in patients with low levels, respectively(χ2/P = 58.022/<0.001, 45.017/<0.001, 47.594/<0.001). The AUCs of serum NLRP3, PGE2, GDF-15, and their combination for predicting CRBSI in hemodialysis patients were 0.780, 0.813, 0.807, and0.941, respectively. The predictive value of the combination was superior to that of each individual marker(Z/P = 5.560/<0.001,5.018/<0.001, 5.047/<0.001). Conclusion Serum NLRP3, PGE2, and GDF-15 levels are elevated in DN patients with concurrent CRBSI during hemodialysis and are positively correlated with IL-6, CRP, and TNF-α. The combination of these three biomarkers shows high predictive value for CRBSI.

Keyword:Diabetic nephropathyHemodialysisCatheter-related bloodstream infectionNOD-like receptor family pyrin domain containing 3Prostaglandin E2Growth differentiation factor 15Prediction

Fund:Health Commission of Hubei Province 2021-2022 Health Research Project Funding (WJ2021M068)