Prognostic value of plasma 7-ketocholesterol in sepsis

Yueyuan Zhang; Sha Xu; Jianxin Xu; Fuchao Xu; Geng Lu; Jiawei Zhou; Shuangshuang Gu; Jun Wang

doi:10.1016/j.cca.2023.117467

Prognostic value of plasma 7-ketocholesterol in sepsis

Clin Chim Acta. 2023 Aug 1:548:117467. doi: 10.1016/j.cca.2023.117467. Epub 2023 Jul 1.

Authors

Yueyuan Zhang¹, Sha Xu¹, Jianxin Xu¹, Fuchao Xu¹, Geng Lu², Jiawei Zhou², Shuangshuang Gu³, Jun Wang⁴

Affiliations

¹ Department of Emergency, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210000, China.
² Department of Emergency, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China.
³ Department of Emergency, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210000, China; Department of Emergency, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China. Electronic address: guss2926@njglyy.com.
⁴ Department of Emergency, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210000, China; Department of Emergency, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210000, China. Electronic address: wjgaogou@aliyun.com.

PMID: 37399884
DOI: 10.1016/j.cca.2023.117467

Abstract

Background: Early evaluation of the severity of sepsis and estimation of its prognosis remains one of the main challenges in current therapeutic strategies. This study aimed to evaluate the prognostic value of plasma 7-ketocholesterol (7-KC) in sepsis.

Methods: We retrospectively measured by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) the plasma 7-KC concentration in 176 patients with sepsis and 90 healthy volunteers. A multivariate Cox proportional hazard model was introduced to identify independent factors, including plasma 7-KC and clinical features, for the 28-day mortality of sepsis, and a nomogram for predicting the 28-day mortality of sepsis was established. Decision curve analysis (DCA) was performed to assess the prediction model of death risk of sepsis.

Results: The area under the curve (AUC) of plasma 7-KC in diagnosing sepsis was 0.899 (95% CI = 0.862-0.935, P < 0.001), while it was 0.830 (95% CI = 0.764-0.894, P < 0.001) in diagnosing septic shock. The AUCs of plasma 7-KC in predicting the survival of sepsis patients in the training cohort and the test cohort were 0.770 (95% CI = 0.692-0.848, P < 0.05) and 0.869 (95% CI = 0.763-0.974, P < 0.05), respectively. In addition, high plasma 7-KC expression predicts poor prognosis in sepsis. Then, 7-KC and platelet count were identified as the two factors with significant differences by a multivariate Cox proportional hazard model, and the 28-day mortality probability ranged from 0.002 to 0.985 and was assessed using a nomogram. DCA results revealed that the combination of plasma 7-KC and platelet count showed the best prognostic efficiency of the risk threshold compared to a single factor in both the training cohort and test cohort.

Conclusions: Collectively, the elevated plasma 7-KC level is an indicator of sepsis and was identified as a prognostic indicator for sepsis patients, providing a landscape for predicting survival in early sepsis with potential clinical utility.

Keywords: 7-ketocholesterol; Biomarkers; Prognosis; Sepsis; Septic shock.

MeSH terms

Chromatography, Liquid
Humans
Prognosis
ROC Curve
Retrospective Studies
Sepsis*
Shock, Septic*
Tandem Mass Spectrometry

Substances

7-ketocholesterol