Clinical significance of sirtuin 1 level in sepsis: correlation with disease risk, severity, and mortality risk

Ye Wen,Senbing Zhang,Xin Cheng,Zhihua Shi

doi:10.1590/1414-431x202010271

Abstract

This study aimed to investigate the value of sirtuin 1 (SIRT1) in differentiating sepsis patients from healthy controls (HCs), and its correlation with inflammation, disease severity, as well as prognosis in sepsis patients. Serum samples were collected from 180 sepsis patients and 180 age- and gender-matched HCs. The SIRT1 level in the serum samples was detected by enzyme-linked immunoassay. The clinical data of the sepsis patients were documented, and their disease severity scores and 28-day mortality rate were assessed. SIRT1 was decreased in sepsis patients compared with HCs, and the receiver operating characteristic curve (ROC) showed that SIRT1 distinguished sepsis patients from HCs (area under the curve (AUC): 0.901; 95% confidence interval (CI): 0.868-0.934). In sepsis patients, SIRT1 negatively correlated with serum creatinine (Scr), white blood cells (WBC), C-reactive protein (CRP), acute physiology, and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score, while it positively correlated with albumin. No correlation of SIRT1 with primary infection site or primary organism was observed. Furthermore, SIRT1 was reduced in 28-day non-survivors compared with 28-day survivors, and subsequent ROC showed that SIRT1 predicted 28-day mortality of sepsis patients (AUC: 0.725; 95% CI: 0.651-0.800), and its prognostic value was not inferior to Scr, albumin, WBC, and CRP, but was less than SOFA score and APACHE II score. In conclusion, measurement of serum SIRT1 might assist with the optimization of disease assessment, management strategies, and survival surveillance in sepsis patients.

Highlights

Sepsis, the commonest cause of emergency admission to the intensive care unit (ICU) globally, develops as an overwhelming, systemic deregulated host response to a microbial infection, which leads to acute tissue damage and organ dysfunction, being associated with a high risk of mortality [1,2,3]
healthy controls (HCs) and 0.587±0.365 ng/mL in sepsis patients, and comparison analysis showed that sirtuin 1 (SIRT1) was significantly lower in sepsis patients compared with HCs (Po0.001) (Figure 1A)
We found that: 1) SIRT1 was reduced in sepsis patients compared with HCs, and the receiver operating characteristic curve (ROC) curve showed that SIRT1 distinguished sepsis patients from HCs; 2) SIRT1 negatively correlated with serum creatinine (Scr), white blood cells (WBC), C-reactive protein (CRP), sequential organ failure assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation (APACHE) II score, whereas it positively correlated with albumin in sepsis patients; and 3) SIRT1 negatively correlated with 28-day mortality, and ROC curve showed that SIRT1 predicted 28-day mortality in sepsis patients

Summary

Introduction

The commonest cause of emergency admission to the intensive care unit (ICU) globally, develops as an overwhelming, systemic deregulated host response to a microbial infection, which leads to acute tissue damage and organ dysfunction, being associated with a high risk of mortality [1,2,3]. Tissue hypoxia, mitochondria dysfunction, and cell apoptosis are important contributors of sepsis-induced organ dysfunction [4]. In spite of intensive clinical and investigational focus on the process of care and treatment of sepsis, the prognosis of sepsis patients remains poor due to the lack of effective biomarkers, and less-than-optimal treatment and supportive care [3]. The investigation of effective biomarkers to facilitate earlier identification and intervention to improve prognosis in sepsis patients is of paramount importance

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