Li Shidan, Jiang Hao, Xing Wei, Wang Shaochuan, Zhang Yao, Li Youbin, Mao Chengyi, Zeng Delian, Lan Ping, Tang Dongqin, Zhan Jijie, Li Lei, Xu Xiang, Fei Jun
Department of Orthopaedics, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People's Republic of China.
Infect Dis Ther. 2022 Jun;11(3):1057-1073. doi: 10.1007/s40121-022-00622-y. Epub 2022 Mar 18.
Infection remains a major cause of morbidity and mortality in hospital. As uncontrolled early infection may develop into systemic infection and eventually progress to sepsis, it is important to address infection at an early stage. Furthermore, early detection and prompt diagnosis of infection are the basis of clinical intervention. However, as a result of the interference of complex aetiologies, including fever and trauma, problems regarding the sensitivity and specificity of current diagnostic indices remain, such as for C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC), neutrophil ratio (NEU%), interleukin-6 (IL-6) and D-dimer. As a result, there is an urgent need to develop new biomarkers to diagnose infection.
From January to October 2021, consecutive patients in the emergency department (ED) were recruited to investigate the feasibility of fibulin-2 as a diagnostic indicator of early infection. Fibulin-2 concentrations in plasma were determined with enzyme-linked immunosorbent assay (ELISA). The performance of fibulin-2 for predicting infection was analysed by receiver operating characteristic (ROC) curves.
We found that the plasma fibulin-2 level was elevated in patients with infection compared with those without infection. ROC curve analysis showed that the area under the curve (AUC) for fibulin-2 was 0.712. For all patients included, the diagnostic ability of fibulin-2 (AUC 0.712) performed as well as CRP (AUC 0.667) and PCT (AUC 0.632), and better than WBC (AUC 0.620), NEU% (AUC 0.619), IL-6 (AUC 0.561) and D-dimer (AUC 0.630). In patients with fever, fibulin-2 performed as well as PCT and better than the other biomarkers in infection diagnosis. In particular, fibulin-2 performed better than all these biomarkers in patients with trauma.
Fibulin-2 is a novel promising diagnostic biomarker for predicting infection.
感染仍然是医院发病和死亡的主要原因。由于未控制的早期感染可能发展为全身感染并最终进展为脓毒症，因此早期处理感染非常重要。此外，感染的早期检测和及时诊断是临床干预的基础。然而，由于包括发热和创伤在内的复杂病因的干扰，目前诊断指标的敏感性和特异性仍然存在问题，如C反应蛋白（CRP）、降钙素原（PCT）、白细胞（WBC）、中性粒细胞比例（NEU%）、白细胞介素-6（IL-6）和D-二聚体。因此，迫切需要开发新的生物标志物来诊断感染。
2021年1月至10月，招募急诊科（ED）的连续患者，以研究纤维连接蛋白-2作为早期感染诊断指标的可行性。采用酶联免疫吸附测定（ELISA）法测定血浆中纤维连接蛋白-2的浓度。通过受试者工作特征（ROC）曲线分析纤维连接蛋白-2预测感染的性能。
我们发现，与未感染患者相比，感染患者的血浆纤维连接蛋白-2水平升高。ROC曲线分析显示，纤维连接蛋白-2的曲线下面积（AUC）为0.712。对于所有纳入的患者，纤维连接蛋白-2（AUC 0.712）的诊断能力与CRP（AUC 0.667）和PCT（AUC 0.632）相当，且优于WBC（AUC 0.620）、NEU%（AUC 0.619）、IL-6（AUC 0.561）和D-二聚体（AUC 0.630）。在发热患者中，纤维连接蛋白-2在感染诊断中的表现与PCT相当，且优于其他生物标志物。特别是，在创伤患者中，纤维连接蛋白-2的表现优于所有这些生物标志物。
纤维连接蛋白-2是一种有前景的新型诊断生物标志物，可用于预测感染。
