Clinical value of hepatic arterial resistance index combined with serum miRNA-122a in diagnosis and prognosis of septic shock complicated with liver injury / 中华急诊医学杂志

ABSTRACT

objective:To investigate the clinical value of hepatic arterial resistance index (HARI) and miRNA-122a in the early diagnosis and prognosis of patients with septic shock complicated with liver injury.Methods:A total of 176 septic shock patients admitted to EICU of Cangzhou Central Hospital from December 2016 to February 2019 were selected as the research subjects. According to the occurrence of acute liver injury, they were divided into the liver injury group (86 cases) and the non-liver injury group (90 cases). Patients in the liver injury group were further divided into the mild liver injury group (20 cases), moderate liver injury group (25 cases), and severe liver injury group (41 cases) according to the degree of liver injury. Patients with septic shock complicated with liver injury were divided into the survival group (26 cases) and non-survival group (60 cases) according to the 28-day mortality. Forty healthy individuals were selected as controls. The clinical data of the subjects were collected. The HARI was determined by bedside color Doppler ultrasonography. The expressions of miRNA-122a in serum were determined by reverse transcriptase polymerase chain reaction (RT-PCR). Receiver operating characteristic (ROC) curves were used to analyze the value of HARI and serum miRNA-122a in the early diagnosis of septic shock combined with liver injury. Binary Logistic regression was used to analyze the prognostic risk factors of septic shock patients with liver injury.Results:① Compared with the control group, there was an increasing trend of HARI and serum miRNA-122a in patients with septic shock without liver injury and patients with septic shock complicated with liver injury, with statistically significant differences ( P <0.01). ROC curve analysis showed that the AUC of HARI and serum miRNA-122a for the diagnosis of septic shock complicated with liver injury were 0.872 (95% CI 0.813, 0.919), and 0.796 (95% CI 0.728, 0.854). When the cut-off of HARI was 0.738, its sensitivity to the diagnosis of septic shock complicated with liver injury was 77.65%, and the specificity was 83.53%; and when the cut-off value of miRNA-122a was 2.80, its sensitivity to the diagnosis of septic shock complicated with liver injury was 71.76%, and the specificity was 75.29%. When the AUC of HARI combined with miRNA-122a for the diagnosis of septic shock complicated with liver injury was 0.927 (95% CI 0.876, 0.961), the optimal cut-off value was 0.276, and its sensitivity to the diagnosis of septic shock complicated with liver injury was 91.76%, with a specificity of 85.29%. ② There was no significant difference in HARI between the non-liver injury group and the mild liver injury group ( P>0.05), while the difference of serum miRNA-122a was statistically significant ( P <0.01). As the severity of liver injury increased, HARI and miRNA-122a expression in patients with septic shock complicated with liver injury showed an increasing trend, with statistically significant differences ( P <0.01). ③ Compared with patients with septic shock with liver injury in the survival group, the liver injury severity, APACHE II score, SOFA score, PCT, HARI and serum miRNA-122a expression levels were significantly increased in the death group, with statistically significant differences ( P <0.01). ④ Binary Logistic regression analysis showed that the severity of liver injury, APACHE II score, SOFA score, HARI and serum miRNA-122a were independent risk factors affecting the prognosis of patients with septic shock with liver injury. Conclusions:HARI combined with serum miRNA-122a test has high sensitivity and specificity in the evaluation of septic shock with liver injury, and have certain clinical value in the evaluation of prognosis of patients with septic shock with liver injury.