ABSTRACT
Objective: To evaluate the clinical value of new coagulation biomarkers including soluble thrombomodulin (sTM) and tissue plasminogen activator inhibitor complex (t-PAI·C) for the diagnosis and prognosis of sepsis in children. Methods: The prospective observational study enrolled 59 children who were diagnosed with sepsis including severe sepsis and septic shock in the Department of Pediatric Critical Care Medicine of Shanghai Children's Medical Center affiliated to the Medical College of Shanghai Jiao Tong University from June 2019 to June 2021. The sTM, t-PAI·C and conventional coagulation tests were detected on illness day one of sepsis. Twenty healthy children were selected as the control group, and the above parameters were detected on the day of inclusion. Children with sepsis were divided into survival group and non-survival group according to prognosis at discharge. Baseline comparisons between groups were performed using Mann-Whitney U test. Multivariate Logistic regression analysis was used to evaluate the risk factors for the diagnosis and prognosis of sepsis in children. Receiver operating characteristic (ROC) curve was conducted to evaluate the predictive values of above variables for the diagnosis and prognosis of sepsis in children. Results: The sepsis group included 59 patients (39 boys and 20 girls), aged 61(22, 136)months. There were 44 patients in the survival group and 15 patients in the non-survival group, respectively. The control group consisted of 20 boys, aged 107 (94,122) months. Patients in the sepsis group had higher sTM and t-PAI·C ((12 (9, 17)×103 vs. 9(8, 10)×103 TU/L, 10(6, 22) vs. 2 (1, 3) μg/L, Z=-2.15, -6.05, both P<0.05) compared with children in the control group. The t-PAI·C was superior to sTM for the diagnosis of sepsis. The areas under the curve (AUC) of t-PAI·C and sTM for the diagnosis of sepsis were 0.95 and 0.66, respectively, and the optimal cut-off value were 3 μg/L and 12×103 TU/L, respectively. Patients in the survival group had lower sTM (10 (8, 14)×103 vs. 17 (11, 36)×103 TU/L, Z=-2.73, P=0.006) than those in the non-survival group. Logistic regression analysis showed that sTM was a risk factor for death at discharge (OR=1.14, 95%CI 1.04-1.27, P=0.006). The AUC of sTM and t-PAI·C for predicting death at discharge were 0.74 and 0.62, respectively, and the optimal cut-off values were 13×103 TU/L and 6 μg/L, respectively. The AUC of sTM combined with platelet counts for predicting death at discharge was 0.89, which was superior to sTM and t-PAI·C. Conclusion: The sTM and t-PAI·C had clinical application values in diagnosing and predicting prognosis in pediatric sepsis.
Subject(s)
Child , Female , Humans , Male , Infant , Child, Preschool , Biomarkers , China , Sepsis/diagnosis , Shock, Septic , Tissue Plasminogen ActivatorABSTRACT
Objective To analyze the expression and clinicopathological significance of seven in absentia homolog 2 (SIAH2) in epithelial ovarian carcinoma, and to discuss its role in the development of epithelial ovarian carcinoma. Methods The expression of SIAH2 was determined by immunohistochemical S-P method in 165 cases of ovarian samples and SIAH2 expression was examined by Western blot. In the combination with follow-up data, survival curves were calculated using the Kaplan-Meier method and relationship between SIAH2 expression and prognosis of ovarian carcinoma patients was analyzed by the log-rank test. Cox proportional hazards regression model was used to examine the independent predictive factors in the patients with epithelial ovarian carcinoma.Results SIAH2 expression in epithelial ovarian cancer (76.4％) was higher than that of borderline ovarian tumors (41.7％) , benign ovarian cysts (5.13％) and normal ovarian tissues (2.86％) , and there were significant differences (all P < 0.05). No statistical significance of SIAH2 expression was found between benign ovarian cysts and normal ovarian tissues (P> 0.05). The expression of the SIAH2 was significantly correlated to histological grade, FIGO stage and lymph node metastasis (P < 0.05).The relative expression of SIAH2 in normal ovarian tissue, benign ovarian cyst, borderline ovarian tumor and epithelial ovarian cancer was 0.12 ± 0.05, 0.11 ± 0.04, 0.57 ± 0.08 and 1.05 ± 0.10, respectively. No difference of SIAH2 expression was found between normal ovarian tissues and benign ovarian cysts (P> 0.05). The expression of SIAH2 increased from ovarian tissues/benign ovarian cysts to borderline ovarian tumor to epithelial ovarian cancer and the difference was statistically significant (all P < 0.05).The survival curves of patients with SIAH2 (+) differed from those of patients with SIAH2 (-) and the difference was statistically significant (P < 0.05). Multiple factor analysis revealed that the higher expression of SIAH2 was an independent prognostic factor for overall survival. Conclusions The over-expression of SIAH2 plays an important role in the tumorigenesis and progression of epithelial ovarian cancer. The over-expression of SIAH2 may serve as a biomarker for poor prognosis of epithelial ovarian cancer patients.
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Purpose To analyze the expression and prognostic value of metastasis-associated protein 2 (MTA2) in epithelial ovarian carcinoma. Methods The expression of MTA2 protein was examined in 91 paraffin-embedded specimens by immunohistochemical SP method, and in fresh specimens by Western blot, and then combined with follow-up data for prognosis analysis. Results There was an increasing tendency in positive rate of MTA 2 expression from benign ovarian cysts (17.5％) to epithelial ovarian cancers (78.43％), and there were significant difference (χ2=33.328, P<0.001). The expression of the MTA2 was significantly correlated to FIGO stage and lymph node metastasis (both P<0.05). The relative expression of MTA2 in benign ovarian cysts and epithelial ovarian cancers was 0.58±0.05, and 1.22±0.10, respectively, and the difference was statistically significant (t=-22.274, P<0.001). The survival curve of patients with MTA2 (+) differed from the survival curve of patients with MTA2 (-) and the difference was statistically significant (χ2=10.203, P<0.05). The multiple factor analysis revealed that the expression of MTA2, FIGO stage and lymph node metastasis were independent prognostic factors for clinical outcome of epithelial ovarian cancer. Conclusion MTA2 may be involved in the progression and metastasis of epithelial ovarian cancer as an oncogene. Overexpression of the marker indicates poor prognosis of patients.