Clinical study on endothelial cell damage, inflammatory factors and coagulation indicators for sepsis in patients with hematological malignancies

Abstract

Objective To investigate the expression of endothelial cell damage, inflammation factors and coagulation indicators for sepsis in patients with hematological malignancies, and to explore the correlation and clinical significance among them. Methods A total of 113 hospitalized patients who were diagnosed with hematological malignancies (except for acute promyelocytic leukemia), were selected in the Affiliated Hospital of Mongolia Medical University from May 2015 to December 2015. According to the degree of infection, these patients were divided into three groups: non-infection group (n = 43), common infection group (n = 31) and sepsis group (n = 39). The general physical data, inflammation indices [procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6)], coagulation related markers [prothrombin time (PT), activated partial thromboplatin time (APTT), D-dimer, antithrombinⅢ (AT-Ⅲ)] and endothelial injury marker [von Willebrand factor (vWF)] were determined and compared among the three groups. The receiver operating characteristic curve (ROC) was drawn. Correlation analysis was performed using Pearson correlation coefficient. Results The comparison of gender, age, temperature, white blood cell count (WBC) and neutrophil count (NEUT) were not significantly different among these groups (all P > 0.05). Compared with the non-infection group, the red blood cell count (RBC) [(3.8 ± 1.0) × 1012/L, (2.9 ± 1.0) × 1012/L, (2.9 ± 0.7) × 1012/L], hemoglobin [(117 ± 24) g/L, (88 ± 26) g/L, (88 ± 20) g/L] decreased significantly in the other two groups. The inflammation indices demonstrated that to compare with the non-infection group, hs-CRP [(4 ± 3) mg/L, (44 ± 20) mg/L, (168 ± 65) mg/L], PCT [0.04 (0.02, 0.08) μg/L, 0.16 (0.06, 0.38) μg/L, 0.80 (0.35, 2.48) μg/L]、IL-6 [(6 ± 4) ng/L, (36 ± 34) ng/L, (150 ± 119) ng/L], and the positive rates of CD64 [(36 ± 21)%, (53 ± 13)%, (69 ± 20)%] in the common infection group and sepsis group all increased, and increased greater in the sepsis group (all P < 0.05). ROC curve analysis showed that the area under curve (AUC), sensitivity and specificity of PCT, the positive rate of CD64, IL-6, and hs-CRP reduced in turn. The coagulation related markers and endothelial injury marker demonstrated that in comparison with the non-infection group, PT [(11.8 ± 1.3) s, (13.6 ± 4.9) s, (14.0 ± 2.4) s], APTT [(29 ± 8) s, (35 ± 10) s, (41 ± 9) s], D-dimer [0.44 (0.34, 1.58) mg/L, 2.35 (1.01, 4.12) mg/L, 5.24 (2.13, 9.87) mg/L], vWF [(126 ± 53)%, (194 ± 66)%, (354 ± 154)%] were all higher in the common infection group and sepsis group, while the activity of AT-Ⅲ was lower in these two groups (all P < 0.05). Pearson correlation analysis showed the level of PCT in the sepsis group positively correlated with PT, APTT (r = 0.432, 0.223; both P < 0.05), and negatively correlated with AT-Ⅲ (r = -0.394, P < 0.001); the positive rate of CD64 positively correlated with PT, APTT, D-dimer (r = 0.302, 0.457, 0.452; all P < 0.05), and negatively correlated with AT-Ⅲ (r = -0.436, P < 0.001). The vWF in the sepsis group positively correlated with the inflammation indices PCT, CD64 (r = 0.341, 0.681; both P < 0.001), and also correlated with the coagulation related markers APTT, D-dimer (r = 0.317, 0.291; both P < 0.05), but negatively correlated with AT-Ⅲ (r = -0.327, P < 0.001). Conclusions PCT and CD64 can provide more accurate basis for early diagnosis of infection in patients with malignant hematological diseases. Multiple markers can more accurately detect infection and predict the possibility of sepsis. Key words: Sepsis; Hematological malignancies; Endothelial cell injury; Inflammatory factors; Coagulation disorders