Predictive value of serum IL-15, pro-ADM and MDH1 for bacterial infection in patients with cirrhosis combined with upper gastrointestinal bleeding

Abstract

Abstract: Objective To investigate the predictive value of serum interleukin-15 (IL-15), adrenomedullin precursor (pro-ADM), and malate dehydrogenase 1 (MDH1) for bacterial infection in patients with cirrhosis and upper gastrointestinal bleeding. Methods A total of 118 patients with liver cirrhosis and upper gastrointestinal bleeding admitted to our hospital from June 2018 to June 2021 were selected as the research subjects.They were divided into infection group (33 cases) and non-infection group (85 cases) according to whether bacterial infection occurred during hospitalization. The clinical data including the levels of serum IL-15, pro-ADM and MDH1 between the 2 groups were compared, and the predictive value of various serum indicators for bacterial infection in patients with cirrhosis with upper gastrointestinal bleeding were analyzed. Results Serum IL-15 (262.59±36.52) ng/mL, pro-ADM (13.14±4.22) nmol/L and MDH1 (627.36±201.78) mU/mL in the infected group were higher than those in the uninfected group [(224.83±27.94) ng/mL, (8.97±2.81) nmol/L, (445.21±142.30) mU/mL], (P<0.05). Serum IL-15 (246.15±32.85) ng/mL, pro-ADM (10.99±3.09) nmol/L, MDH1 (531.10±114.36) mU/mL in patients with Child-Pugh classification B or C were higher than those in patients with class A [(212.73±23.59) ng/mL, (8.35±2.26) nmol/L, (422.58±102.45) mU/mL], (P<0.05). Serum IL-15 (248.28±29.67) ng/mL, pro-ADM (11.19±2.58) nmol/L, MDH1 (571.57±137.48) mU/mL in patients with moderate to severe upper gastrointestinal bleeding were higher than those in patients with mild bleeding [(221.60±21.51) ng/mL, (9.02±2.13) nmol/L, (415.44±113.29) mU/mL], (P<0.05). Serum IL-15 (251.83±31.42) ng/mL, pro-ADM (11.48±2.97) nmol/L, MDH1 (563.57±148.22) mU/mLin patients with APACHE II score >21 were higher than those in in patients with score ≤21 [(212.24±20.66) ng/mL, (8.26±2.05) nmol/L, (401.21±109.63) mU/mL], (P<0.05). The results of pearson correlation analysis showed that serum IL-15, pro-ADM, and MDH1 were positively correlated with Child-Pugh classification, severity of upper gastrointestinal bleeding, and APACHE II score (P<0.05). The rusults of logistic regression analysis showed that serum IL-15, pro-ADM, and MDH1 were independently associated with bacterial infection in patients with cirrhosis with upper gastrointestinal bleeding before and after correction for other factors (P<0.05). In ROC curve analysis, the AUC of the combination of serum IL-15, pro-ADM and MDH1 in predicting bacterial infection in patients with cirrhosis and upper gastrointestinal bleeding was 0.931 (95% CI: 0.869-0.970, specificity 90.91%, sensitivity 80.95%), which was better than the predictive value of each index alone 0.844 (95% CI: 0.765 to 0.904), 0.737 (95% CI: 0.648 to 0.814) and 0.744 (95% CI: 0.655 to 0.820). Conclusion Serum IL-15, pro-ADM, and MDH1 can be used as predictors of bacterial infection in patients with cirrhosis and upper gastrointestinal bleeding, and the combined predictive value is more reliable and can provide effective information for clinical prevention and treatment of concurrent bacterial infection in such patients.

Key words: Cirrhosis, Upper gastrointestinal bleeding, Bacterial infection, Interleukin-15, Adrenomedullin precursor, Malate dehydrogenase 1, Predictive value

ZHUANG Xiao-lei, ZOU Hong-rui, HOU Jing-yue. Predictive value of serum IL-15, pro-ADM and MDH1 for bacterial infection in patients with cirrhosis combined with upper gastrointestinal bleeding[J]. Chinese Hepatolgy, 2023, 28(6): 654-659.

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