ABSTRACT
Objective: This study aimed to assess the association between Red Cell Distribution Width-to-Albumin Ratio (RAR) and the clinical outcomes in Pediatric Intensive Care Unit (PICU) patients. Design: This is a retrospective cohort study. Methods: We conducted a retrospective cohort study based on the Pediatric Intensive Care database. The primary outcome was the 28-day mortality rate. Secondary outcomes included the 90-day mortality rate, in-hospital mortality rate, and length of hospital stay. We explored the relationship between RAR and the prognosis of patients in the PICU using multivariate regression and subgroup analysis. Results: A total of 7,075 participants were included in this study. The mean age of the participants was 3.4 ± 3.8 years. Kaplan-Meier survival curves demonstrated that patients with a higher RAR had a higher mortality rate. After adjusting for potential confounding factors, we found that for each unit increase in RAR, the 28-day mortality rate increased by 6% (HR = 1.06, 95% CI: 1.01-1.11, P = 0.015). The high-RAR group (RAR ≥ 4.0) had a significantly increased 28-day mortality rate compared to the low-RAR group (RAR ≤ 3.36) (HR = 1.7, 95% CI: 1.23-2.37, P < 0.001). Similar results were observed for the 90-day and in-hospital mortality rate. No significant interactions were observed in the subgroup analysis. Conclusion: Our study suggests a significant association between RAR and adverse outcomes in PICU patients. A higher RAR is associated with higher 28-day, 90-day, and in-hospital mortality rates.
ABSTRACT
BACKGROUND Microglial cell activation is the first response to spinal cord injury (SCI). The purpose of the study was to investigate the role and mechanism of tripartite motif containing 52 (TRIM52) in microglial cell activation and the inflammatory response. MATERIAL AND METHODS The cerebral cortex was isolated in rats, and primary microglial cells were subsequently incubated for 7 to 9 days and activated by lipopolysaccharide (LPS). TRIM52 overexpression and interference lentivirus were constructed, and primary microglial cells were transfected. Cytokine levels of interleukin-1ß and tumor necrosis factor-a were detected using enzyme-linked immunosorbent assay kits. TRIM52 mRNA expression and protein levels were examined by real-time polymerase chain reaction and nuclear factor-kappa B (NF-kappaB) and inhibitory kappa B-alpha (IkappaBalpha) protein expression were examined by western blot. The interaction between TRIM52 and IkappaBalpha was analyzed by co-immunoprecipitation (Co-IP) detection. Microglial marker Iba-1 and microglial cell activation marker OX-42 were detected by immunofluorescent staining. RESULTS Primary rat microglial cells were successfully isolated and activated by LPS. The expression levels of cytokines and TRIM52 and nuclear accumulation of NF-kappaB in microglial cells all increased in a dose-dependent manner with LPS. Cytokine and nuclear NF-kappaB levels decreased after TRIM52 knockdown, while the opposite expression pattern was found in microglial cells transfected with TRIM52 gene overexpression lentivirus. Co-IP revealed the association between TRIM52 and IkappaBalpha, and overexpressed TRIM52 promoted the ubiquitination of IkappaBalpha and significantly reduced its protein expression. CONCLUSIONS TRIM52 activated the NF-kappaB signaling pathway by promoting IkappaBalpha ubiquitination, thereby regulating LPS-induced microglial cell activation and the inflammatory response.
