Predictive value of combined serum HSP70 and Caspase-3 for delayed encephalopathy after acute carbon monoxide poisoning

doi:10.3877/cma.j.issn.1674-0785.2022.01.013

Abstract

Abstract:

Objective

To investigate the predictive value of combined serum heat shock protein 70 (HSP70) and cysteine aspartate protease-3 (Caspase-3) for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).

Methods

A total of 191 patients with acute carbon monoxide poisoning (ACMP) treated at 3201 Hospital Affiliated to Xi'an Jiaotong University School of Medicine from January 2019 to January 2021 were selected, and they were divided into either a DEACMP group (n=78) or an ACMP-only group (n=113) according to whether delayed encephalopathy occurred or not. Another 57 physically healthy people were selected as a control group. General data of the patients were collected, and serum HSP70 and Caspase-3 levels were measured by ELISA. The correlation between serum HSP70 and Caspase-3 levels in ACMP patients was analyzed using Spearman correlation. Multi-factor Logistic regression was used to analyze the factors influencing DEACMP, and ROC curves were plotted to analyze the predictive value of serum HSP70 and Caspase-3 levels for DEACMP.

Results

Serum HSP70 and Caspase-3 levels were significantly higher in the ACMP group than those in the control group [HSP70: 27.46 (24.11, 31.29) ng/mL vs 12.38 (8.68, 16.13) ng/ml, t/Z=-11.362, P<0.001; Caspase-3: (27.35±5.72) ng/L vs (16.47±4.03) ng/L, t/Z=13.401, P＜0.001]. There was a positive correlation between serum HSP70 and Caspase-3 levels in ACMP patients (r_s=0.724, P＜0.001). Age [odds ratio (OR)=1.101, 95% confidence interval (CI): 1.019-1.189], duration of carbon monoxide (CO) exposure (OR=1.311, 95%CI: 1.123-1.530), impaired consciousness＞48 h (OR=3.531, 95%CI: 1.133-11.000), HSP70 (OR=1.264, 95%CI: 1.154-1.384), and Caspase-3 (OR=1.244, 95%CI: 1.135-1.363) were independent risk factors for DEACMP (P＜0.05). HSP70 combined with Caspase-3 had a greater area under the curve (AUC) predicting for DEACMP than either of HSP70 and Caspase-3 alone (P＜0.05).

Conclusion

Serum HSP70 and Caspase-3 levels in ACMP patients are elevated, which are independent risk factors for DEACMP. The combined detection of serum HSP70 and Caspase-3 levels can improve the prediction of DEACMP.

Key words: Acute carbon monoxide poisoning, Delayed encephalopathy, Apoptosis, Heat shock protein 70, Cysteine aspartate protease-3

Fei Xu, Rong Tang, Jianjun Liang, Zhigang Fan. Predictive value of combined serum HSP70 and Caspase-3 for delayed encephalopathy after acute carbon monoxide poisoning[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(01): 71-76.

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Figures/Tables 5

项目	DEACMP组（78例）	单纯ACMP组（113例）	统计值	P值
性别（男/女，例）	32/46	58/55	χ²=1.965	0.161
年龄（岁， $x ¯$ ±s）	45.82±7.91	43.27±5.58	t=2.618	0.01
体质量指数（kg/m²， $x ¯$ ±s）	21.78±2.06	22.34±2.01	t=-1.853	0.065
基础疾病［例（%）］
高血压	24（30.77）	21（18.58）	χ²=3.805	0.051
糖尿病	13（16.67）	16（14.16）	χ²=0.225	0.635
高血脂症	20（25.64）	23（20.35）	χ²=0.739	0.39
吸烟［例（%）］	16（20.51）	20（17.70）	χ²=0.239	0.625
饮酒［例（%）］	17（21.79）	23（20.35）	χ²=0.058	0.81
文化程度［例（%）］			χ²=0.649	0.723
小学及以下	37（47.44）	47（41.59）
初中	24（30.77）	38（33.63）
高中及以上	17（21.79）	28（24.78）
CO暴露时间（h， $x ¯$ ±s）	10.42±2.91	8.53±2.93	t=4.372	＜0.001
意识障碍＞48 h［例（%）］	18（23.08）	11（9.73）	χ²=6.379	0.012
首次高压氧后清醒＞48 h［例（%）］	22（28.21）	16（14.16）	χ²=5.713	0.017
HSP70［ng/ml，M（P₂₅，P₇₅）］	30.14（26.53，34.36）	25.00（22.10，28.77）	Z=-6.28	＜0.001
Caspase-3（ng/L， $x ¯$ ±s）	30.35±5.28	25.28±5.07	t=6.679	＜0.001

项目	DEACMP组（78例）	单纯ACMP组（113例）	统计值	P值
性别（男/女，例）	32/46	58/55	χ²=1.965	0.161
年龄（岁， $x ¯$ ±s）	45.82±7.91	43.27±5.58	t=2.618	0.01
体质量指数（kg/m²， $x ¯$ ±s）	21.78±2.06	22.34±2.01	t=-1.853	0.065
基础疾病［例（%）］
高血压	24（30.77）	21（18.58）	χ²=3.805	0.051
糖尿病	13（16.67）	16（14.16）	χ²=0.225	0.635
高血脂症	20（25.64）	23（20.35）	χ²=0.739	0.39
吸烟［例（%）］	16（20.51）	20（17.70）	χ²=0.239	0.625
饮酒［例（%）］	17（21.79）	23（20.35）	χ²=0.058	0.81
文化程度［例（%）］			χ²=0.649	0.723
小学及以下	37（47.44）	47（41.59）
初中	24（30.77）	38（33.63）
高中及以上	17（21.79）	28（24.78）
CO暴露时间（h， $x ¯$ ±s）	10.42±2.91	8.53±2.93	t=4.372	＜0.001
意识障碍＞48 h［例（%）］	18（23.08）	11（9.73）	χ²=6.379	0.012
首次高压氧后清醒＞48 h［例（%）］	22（28.21）	16（14.16）	χ²=5.713	0.017
HSP70［ng/ml，M（P₂₅，P₇₅）］	30.14（26.53，34.36）	25.00（22.10，28.77）	Z=-6.28	＜0.001
Caspase-3（ng/L， $x ¯$ ±s）	30.35±5.28	25.28±5.07	t=6.679	＜0.001

项目	β	SE	Waldχ²值	P值	OR值（95%CI）
年龄	0.096	0.039	5.917	0.015	1.101（1.019~1.189）
CO暴露时间	0.271	0.079	11.758	0.001	1.311（1.123~1.530）
意识障碍时间＞48 h	1.262	0.580	4.735	0.030	3.531（1.133~11.000）
首次高压氧后清醒时间＞48 h	0.593	0.500	1.406	0.236	1.810（0.679~4.827）
HSP70	0.234	0.046	25.489	＜0.001	1.264（1.154~1.384）
Caspase-3	0.218	0.047	21.935	＜0.001	1.244（1.135~1.363）

指标	AUC值（95%CI）	约登指数	截断值	敏感度（%）	特异度（%）
HSP70	0.768（0.701~0.826）	0.424	28.78 ng/ml	65.38	76.99
Caspase-3	0.742（0.674~0.803）	0.348	32.11 ng/L	41.03	93.81
HSP70＋Caspase-3	0.848（0.789~0.895）	0.586	-	69.23	89.38

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