Correlation between thrombopoietin and inflammatory factors, platelet indices, and thrombosis in patients with sepsis: A retrospective study.

BACKGROUND: Thrombopoietin (TPO) is a primary regulator of thrombopoiesis in physiological conditions. TPO, in combination with its specific cytokine receptor c-Mpl, drives platelet production by inducing the proliferation and differentiation of megakaryocytes. However, the role of TPO in sepsis is not well determined. The elevated levels of TPO are often accompanied by a decrease of platelet count (PLT) in systemic infected conditions, which is contrary to the view that TPO promotes platelet production under physiological conditions. In addition, whether TPO mediates organ damage in sepsis remains controversial. AIM: To explore the relationships between TPO and inflammatory factors, platelet indices, and thrombotic indicators in sepsis. METHODS: A total of 90 patients with sepsis diagnosed and treated at the emergency medicine department of The First People's Hospital of Foshan between January 2020 and March 2021 were enrolled in this study. In addition, 110 patients without sepsis who came to the emergency medicine department were included as controls. Clinical and laboratory parameters including age, gender, TPO, blood cell count in peripheral blood, platelet indices, inflammatory factors such as high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-21, and IL-6, organ damage indicators, and thrombotic indicators were collected and analyzed by using various statistical approaches. RESULTS: The results showed that the TPO levels were higher in the sepsis group than in controls [86.45 (30.55, 193.1) vs 12.45 (0.64, 46.09) pg/mL, P < 0.001], but PLT was lower (P < 0.001). Multivariable analysis showed that white blood cell count (WBC) [odds ratio (OR) = 1.32; 95% confidence interval (CI): 1.01-1.722; P = 0.044], TPO (OR = 1.02; 95%CI: 1.01-1.04; P = 0.009), IL-21 (OR = 1.02; 95%CI: 1.00-1.03; P = 0.019), troponin I (OR = 55.20; 95%CI: 5.69-535.90; P = 0.001), and prothrombin time (PT) (OR = 2.24; 95%CI: 1.10-4.55; P = 0.027) were independent risk factors associated with sepsis. TPO levels were positively correlated with IL-21, IL-6, hs-CRP, creatinine, D-dimer, PT, activated prothrombin time, international normalized ratio, fibrinogen, WBC count, and neutrophil count, and negatively correlated with PLT, thrombin time, red blood cell count, and hemoglobin concentration (P < 0.05). Receiver operating characteristic analysis showed that TPO had fair predictive value in distinguishing septic patients and non-septic patients (the area under the curve: 0.788; 95%CI: 0.723-0.852; P < 0.001). With an optimized cutoff value (28.51 pg/mL), TPO had the highest sensitivity (79%) and specificity (65%). CONCLUSION: TPO levels are independently associated with sepsis. High TPO levels and low PLT suggest that TPO might be an acute-phase response protein in patients with infection.

[Changes of Thrombopoietin Levels in Patients with Acute Inflammatory Disease and Its Significance].

OBJECTIVE: To investigate the changes of TPO levels in patients with acute inflammatory response disease of different etiologies. METHODS: In the case -control study, 65 patients with acute inflammatory response disease were enrolled in the case group (15 patients with acute myocardial infarction, 15 patients with acute cerebral infarction, 25 patients with acute trauma and 10 patients with acute pneumonia), and 42 healthy subjects were selected as the control group. The levels of TPO in peripheral blood and blood cell counts between the case group and the control group were compared by Student's t test for examing whether the level of TPO in acute inflammation states was higher than that in healthy people. And, by using Kruskal-Wallis H test and Nemenyi test, subsequent subgroup compaison was performed to assess whether there was a difference in TPO levels under the condition of inflammation of different etiologies and at different levels. RESULTS: Compared with the control group,serum TPO levels in case group were significantly higher (181.11±35.38 vs 96.13±9.7 pg/ml)(P<0.001), and the white blood cell count in case group (9.64±3.43)×109/L was higher than that in control group(7.35±1.49)×109/L(P<0.001), but the platelet count in the case group was not statistically different from that in the control group (P=0.313). In the further subgroup analysis, it was found that changes in TPO level were different in different levels of inflammation. The level of TPO in patients with inflammatory disease of high level(acute trauma, acute pneumonia) was greatly higher than that in patients with inflammatory disease of low level(acute myocardial infarction, acute cerebral infarction) (P<0.05), and there was no statistically significant difference in platelet count among subgroups. CONCLUSION: In acute inflammation states, the increase of serum TPO levels does not correlate with platelet counts, but correlates with inflammation levels, and TPO may act as an acute response protein to protect the body.

[Study on species identification of Mycobacteria by gas chromatography analysis of whole-cell fatty acid].

OBJECTIVE: To evaluate the accuracy and applicability of species identification method of Mycobacteria by applying gas chromatography analysis of whole-cell fatty acid. METHODS: Species identification of 14 reference strains and 727 clinical isolates of Mycobacteria were performed by using MIDI Sherlock Microbial Identification System (MIS)4.0 based on gas chromatography analysis of whole-cell fatty acid, and the results were compared with those of conventional species identification method. RESULTS: (1) By using the conventional method, all 14 reference strains were identified correctly. Except for Mycobacterium.vaccae, the result obtained by MIS were identical to that of conventional method. (2) Among 625 clinical isolates identified as Mycobacterium tuberculosis (MTB) and Mycobacterium bovis, 45 strains were mistakenly identified as Nontuberculous Mycobacteria (NTM) by MIS. Its accuracy was 93%. For 102 NTM strains, results of group identification showed no difference between the two methods. However, 7 results of species identification were not consistent, the accuracy being 93%. (3) MIS mainly mistook MTB for Mycobacterium gastri, Mycobacterium trivial and Mycobacterium smegmatis, and Mycobacterium scrofulaceum for Mycobacterium gordonae among NTM. CONCLUSIONS: The results of species identification of Mycobacteria by applying gas chromatography analysis of whole-cell fatty acid are in accordance with those of conventional method for the majority of the strains, and MIS can identify Mycobacteria to species level by a single experiment. It can be considered as a good method for species identification of Mycobacteria in terms of its accuracy and applicability.

[A study on the correlation between HLA-DR genes and susceptibility to pulmonary tuberculosis in a population of Han nationality from southern China].

OBJECTIVE: To analyze the association between HLA-DR genes and pulmonary tuberculosis and to explore susceptible genes associated with pulmonary tuberculosis in a population of Han nationality from southern China. METHODS: Using case-control study, we detected by polymerase chain reaction-sequence specific primers (PCR-SSP) technique the 23 alleles of HLA-DR gene sites in 110 tuberculosis cases and 101 controls from Guangdong, Guangxi, Hunan, Hubei, Jiangxi and Fujian provinces. Gene frequency (GF) and odds ratio (OR) were calculated and compared. RESULTS: The frequency of DR16 allele in pulmonary tuberculosis cases was strikingly higher than that in the healthy controls (chi2=5.915, Pc< 0.05). Their GFs were 12.62% and 5.60% respectively, and the OR was 2.53. Significantly decreased frequency of DR1 and DR13.3 alleles in cases were found (chi2 values were 17.847 and 14.258 respectively, Pc < 0.01). Their ratios of GFs were 8.08% vs. 23.57% and 29.29% vs. 50.24%, and their ORs were 0.26 and 0.33 respectively. CONCLUSIONS: The results suggest that DR16 allele is closely correlated to incidence of pulmonary tuberculosis in this population of Han nationality from southern China, or linked to susceptible genes which are functional. It is also suggested that expression of DR1 and DR13.3 alleles may be associated with an antagonist effect in the pathogenesis of pulmonary tuberculosis in this population.