The clinical significance of changes in plasma mitochondrial DNA in children with sepsis / 中华急诊医学杂志

ABSTRACT

Objective To observe the dynamic changes of plasma mitochondrial DNA (mtDNA) in children with sepsis in order to explore the clinical value of it in evaluation of these cases. Methods A total of 37 sepsis children admitted from June 2016 to January 2017 in the intensive care unit of Hunan Children's Hospital were enrolled for this prospectively study. And another 27 healthy children with similar age and gender were randomly selected as the control group. The venous blood samples were taken on the 1st, 3rd and 7th day after admission. Fluorescence quantitative PCR was used to detect the plasma mtDNA level. Meanwhile, the laboratory examinations such as detections of CRP and PCT were carried out. The diagnosis of sepsis and septic shock was based on Sepsis Criteria 3. Patients with genetic metabolic disease, liver and kidney disease, end-stage of tumors were excluded. Data of two groups were analyzed with Mann-Whitney U test. The sensitivity and specifi city were assessed by receiver operating curve (ROC). Results The plasma mtDNA level in the sepsis group 3 384.4(1 368.5, 6 857.5) pg/mL was higher than that in the healthy control group 1 904.8(1 267.9, 2 395.5) pg/mL with statistical signifi cance (P<0.05). The levels of plasma mtDNA in the sepsis multi-organ dysfunction group were higher than those in the single organ disorder group at day 1,3,7, with statistically signifi cant in three intervals (P <0.05). The level of plasma mtDNA in sepsis group were signifi cantly higher than those in non-shock group at day 1,3,7, with statistical difference (P <0.05). The plasma mtDNA levels in the non-survival group were higher than those in survival group 13 515.1(4 832.7,152 348.5)vs.2 780.0(1 226.8,5 261.2)on day 1;5 842.4(3 402.8,101 937.5)vs.1 450.5(710.6,2 481.6)on day 3 with statistical difference(P<0.05).there was no significant difference in mtDNA on day 7 was 1 045.1 vs.741.8(334.0,1 254.6)between survival group and non-survival group (P >0.05). In respect of diagnostic effi cacy of plasma mtDNA, PCT and CRP in predicting sepsis MODS, the largest area under the ROC curve of plasma mtDNA was 0.848 occurring on the 1st day, when the critical value was 2 176.2 pg/mL, the sensitivity and specifi city was 89% and 72%, respectively, and the difference was statistically signifi cant(P<0.01). When the critical value of CRP was 71.3 mg/L, the sensitivity and specifi city was 58% and 67% respectively. When the critical value of PCT was 7.24 ng/L, the sensitivity and specifi city were 84% and 61%, respectively. The plasma mtDNA peaked on day 1 followed by a downward changes. Conclusions The elevated level of plasma mtDNA in sepsis children was associated with organ dysfunction, indicating that it can be used as one of biomarkers for the diagnosis of sepsis MODS in children. The level of plasma mtDNA in children with sepsis was significantly high on the first and third day after admission, which was positively correlated with the severity of sepsis and it has certain value in assessment of the disease.