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Objective:To evaluate iron metabolism disorders in sepsis patients and explore the effect of iron deficiency on mortality.Methods:Patients ( n=130) who were admitted to the emergency intensive care unit (ICU) of the First Affiliated Hospital of Dalian Medical University from September 2016 to July 2018 and met the diagnostic criteria of Sepsis 3.0 were selected, and sex- and age-matched healthy volunteers ( n=20) were enrolled as a control group. Peripheral venous blood samples were collected in sepsis patients on day 1, 3 and 7 after admission, or in the healthy volunteers upon enrollment, to detect iron metabolism-related indicators and interleukin-6 (IL-6); the Sequential Organ Failure Assessment (SOFA) score was calculated upon hospital admission. Iron metabolism-related indicators were compared between the groups; the correlation of plasma iron with hemoglobin, hepcidin, ferritin, IL-6, sTFR/log ferritin and the ability of plasma iron to predict 28-day death of sepsis patients were analyzed. Results:Sepsis patients developed significant anemia on day 3 after admission; plasma iron, transferrin, iron saturation, total iron binding capacity and unsaturated iron binding capacity in the first week of admission were significantly lower than those in the control group; distribution width of red blood cells, ferritin, IL-6, hepcidin and soluble transferrin receptor were significantly higher than those in the control group. Distribution width of red blood cells, ferritin and hepcidin on day 3 and 7 after admission, and plasma iron and iron saturation on day 7 after admission were significantly higher than those on day 1. However, total iron binding capacity and unsaturated iron binding power on day 7, and sTFR/log ferritin on day 3 were significantly lower than those on day 1. Patients in the survival and non-survivor groups in the first week of admission had significant anemia on day 3 and 7, but the anemia was worse in the non-survivor group. Transferrin, total iron binding capacity, and unsaturated iron binding capacity in the non-survivor group in the first week of admission, and plasma iron in the non-survivor group on day 3 and 7, were significantly lower than those in the survival group. Ferritin, IL-6 and hepcidin in the non-survivor group in the first week of admission, and iron saturation on day 7 were significantly higher than those in the survival group. Spearman correlation analysis showed that plasma iron was negatively correlated with IL-6 ( r=-0.391, P<0.01), ferritin ( r=-0.293, P=0.001) and hepcidin ( r=-0.209, P=0.017), but not with hemoglobin ( r=0.005, P=0.958). The area under the operation curve (AUC) for plasma iron for predicting 28-day mortality in sepsis patients was 0.524 (95% CI: 0.416-0.631, P=0.656). Conclusions:Sepsis patients have significant anemia and iron metabolism disorders in the early stage, while non-survival patients are more severe. Reduced plasma iron level has no capacity to predict 28-day mortality of sepsis patients. In addition, decreased plasma iron level is not related to decreased hemoglobin, and thus iron supplementation should be cautious in sepsis patients.
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Objective To explore the effect of Ulinastatin on the iron metabolism,severity and prognosisof septic patients.Methods A total of 98 septic patients who met the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were collected in the Emergency Intensive Care Unit of First Affiliated Hospital of Dalian Medical University from January 2017 to December 2017.Patients were randomly divided into the conventional treatment group (n=49) and Ulinastatin group (n=49).In addition,healthy volunteers matched for gender and age were selected as the control group (n=20).On days 1 (when enrolled for healthy volunteers),3 and 7 after admission peripheral venous blood was collected for routine blood test;the levels of plasma ferritin,erythropoietin (EPO),soluble transferrin receptor (sTFR),hepcidin and intedeukin-6 (IL-6) were measured using enzyme-linked immunosorbent assay (ELISA) and the sTFR/log ferritin index was calculated.SOFA score was assessed and the survival time was recorded within 28 days after admission.Results On days 1,3,and 7 after admission red cell distribution width and plasma EPO,sTFR,hepcidin,ferritin and IL-6 were significantly increased and hemoglobin and sTFR/log ferritin were significantly decreased in the conventional treatment group compared with those in the control group (all P＜0.05);on days 3 and 7 after admission plasma hepcidin,ferritin and IL-6 were significantly decreased and plasma EPO and sTFR/log ferritin were significantly increased in the Ulinastatin group compared with those in the conventional treatment group (all P＜0.05).On day 7 after admission SOFA score in the Ulinastatin group was significantly decreased compared with that in the conventional treatment group [(5.2±2.3) vs (6.4±2.7),P=0.019)].There was no significant difference in the 28-day survival rate (47％ vs 43％) and the survival time (18 d vs 9 d) after admission between the conventional treatment and Ulinastatin groups (both P＞0.05).Conclusions Iron metabolism disorder and inflammatory anemia occur in the early stage of septic patients.Ulinastatin might improve the iron metabolism disorder and the severity,but it cannot significantly improve anemia and prognosis of septic patients.
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Objective To observe secreted protein acidic and rich in cysteine (SPARC) levels in serum and foot muscle tissue of patients with type 2 diabetic foot (DF).Methods All participants were divided into four groups with 40 cases in each group, including type 2 diabetic patients without (DMA) and with (DMB) lower limb arterial sclerosis and peripheral neuropathy, DF group, and normal control (NC) group.The muscle tissues of foot from DF group (n =6) and NC group (n =6) were taken.Serum SPARC level was measured with ELISA.RT-PCR, Western blot, immunofluorescence, and immunohistochemistry were used to examine SPARC mRNA and protein expressions in the foot muscle.Results Serum SPARC levels were higher in DMA and DMB groups compared with NC and DF groups[(1 040.48 ±212.12 and 1 068.36 ± 165.45 vs 841.93 ± 144.57 and 835.43 ± 188.37) ng/L, P＜ 0.01].There was no significant difference in serum SPARC level between DF and NC groups or DMA and DMB groups (P＞0.05).The expression levels of SPARC mRNA and protein in the foot muscle were higher in DF compared with NC group (P＜0.05).Conclusion SPARC mRNA and protein expressions in foot muscle tissue are higher in DF group compared with control group, indicating that SPARC may participate in the repair and healing of damaged muscle tissue of diabetic foot.
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Objective To investigate the serum concentrations of secreted protein acidic and rich in cysteine (SPARC) in patients with diabetic nephropathy and SPARC mRNA and protein expressions in renal tissue of db/db mice.Methods Serum SPARC levels in normal subjects and patients with type 2 diabetes mellitus (without diabetic nephropathy),chronic renal failure (without diabetes mellitus),and diabetic nephropathy were determined with enzyme-linked immunosorbent assay.RT-PCR,Western blot,and immunofluorescence were used to detect the mRNA and protein expressions of SPARC in renal tissue of db/db mice.Results The serum level of SPARC in diabetic nephropathy group was significantly higher than those in normal group,type 2 diabetes mellitus,and chronic renal failure group [(5.78 ± 1.41 vs 3.58 ±0.41,4.51 ± 1.08,and 3.81 ± 1.16) μg/L,P＜0.05 or P＜0.01].The SPARC level in the type 2 diabetes mellitus group was higher than that in normal group (P＜0.05),but there was no difference between normal group and chronic renal failure.SPARC mRNA and protein levels in renal tissue of db/db mice were higher compared with the littermates (P ＜ 0.05).Conclusions The long term hyperglycemic state in patients with diabetic nephropathy causes pathological change of renal tissue.Simultaneously,increased secretion of SPARC from renal tissue results in elevation of serum SPARC level and may play a role in pathological change of diabetic nephropathy.