Published online Feb 16, 2024. doi: 10.12998/wjcc.v12.i5.966
Peer-review started: November 16, 2023
First decision: December 26, 2023
Revised: December 30, 2023
Accepted: January 24, 2024
Article in press: January 24, 2024
Published online: February 16, 2024
Processing time: 75 Days and 17.6 Hours
The diagnosis of sepsis combined with acute respiratory distress syndrome (ARDS) has increased owing to the enhanced awareness among medical professionals and the continuous development of modern medical technologies, while early diagnosis of ARDS still lacks specific biomarkers. One of the main pathogenic mechanisms of sepsis-associated ARDS involves the actions of various pathological injuries and inflammatory factors, such as platelet and white blood cells activation, leading to an increase of surface adhesion molecules. These adhesion molecules further form platelet-white blood cell aggregates, including platelet-mononuclear cell aggregates (PMAs). PMAs has been identified as one of the markers of platelet activation, here we hypothesize that PMAs might play a potential biomarker for the early diagnosis of this complication.
To investigate whether PMAs could be a potential biomarker for the early diagnosis of sepsis combined with ARDS.
To investigate the clinical significance of PMAs in patients with sepsis complicated by ARDS.
72 patients diagnosed with sepsis were enrolled in the study between March 2019 and March 2022. Among them, 30 patients with sepsis and ARDS formed the study group, while 42 sepsis patients without ARDS comprised the control group. After diagnosis, venous blood samples were immediately collected from all patients. Flow cytometry was employed to analyze the expression of PMAs, platelet neutrophil aggregates (PNAs), and Platelet Aggregates (PLyAs) in the serum. Additionally, the Acute Physiology and Chronic Health Evaluation (APACHE) II score was calculated for each patient, and Receiver operating characteristic curves were generated to assess diagnostic value.
The levels of PNAs and PLyAs in the serum of the study group were higher than those in the control group, but the difference was not statistically significant (P > 0.05). However, the expression of PMAs in the serum of the study group was significantly upregulated (P < 0.05) and positively correlated with the APACHE II score (r=0.671, P < 0.05). When using PMAs as a diagnostic indicator, the area under the curve value was 0.957, indicating a high diagnostic value (P < 0.05). Furthermore, the optimal cutoff value was 8.418%, with a diagnostic sensitivity of 0.819 and specificity of 0.947.
The serum levels of PMAs significantly increase in patients with sepsis and ARDS, which might have the potential to become a new biomarker for clinically diagnosing sepsis complicated by ARDS.
Our study provides a new method for the early diagnosis of sepsis combined with ARDS, which is the detection of serum PMAs. More samples should be enrolled to confirm this method in the future study.