Expression and clinical significance of peripheral blood eNAMPT and sDR5 in patients with sepsis-associated acute respiratory distress syndrome

Jiang Shaoxiong; Xia Yiqin; Liu Lipeng; Zhu Xiaolin; Cai Binrong; Shen Jing

doi:10.3969/j.issn.1671-6450.2025.04.002

Abstract：Objective To investigate the expression and clinical significance of extracellular nicotinamide phospho-ribosyl transferase(eNAMPT)and soluble death receptor 5(sDR5)in patients with sepsis-associated acute respiratory dis-tress syndrome(SA-ARDS).Methods A total of 205 SA-ARDS patients admitted to the Emergency Department of West China Hospital,Sichuan University from January 2021 to July 2024 were selected as the SA-ARDS group,and 114 healthy volunteers from the hospital's health check-up center were selected as the healthy control group.Based on the severity of the disease,the SA-ARDS patients were divided into three subgroups:mild SA-ARDS(62 cases),moderate SA-ARDS(74 cases),and severe SA-ARDS(69 cases).According to the 28-day prognosis,they were further divided into the death sub-group(80 cases)and survival subgroup(125 cases).Serum eNAMPT and sDR5 levels were detected by enzyme-linked im-munosorbent assay.Spearman correlation analysis was performed to assess the correlation between serum eNAMPT,sDR5 levels,and the oxygenation index in SA-ARDS patients.Multivariate unconditional logistic regression analysis was used to examine the relationship between serum eNAMPT,sDR5 levels,and mortality in SA-ARDS patients.The diagnostic perform-ance of serum eNAMPT and sDR5 levels was evaluated by receiver operating characteristic(ROC)curve analysis.Results Compared with the healthy control group,serum eNAMPT and sDR5 levels in the SA-ARDS subgroups were significantly elevated(t/P=14.006/＜0.001,19.931/＜0.001).Serum eNAMPT and sDR5 levels increased progressively in the mild,moder-ate,and severe SA-ARDS subgroups(F/P=97.467/＜0.001,157287/＜0.001).Serum eNAMPT and sDR5 levels were nega-tively correlated with the oxygenation index(r/P=-0.724/＜0.001,-0.720/＜0.001).Prolonged intensive care unit(ICU)stay,mechanical ventilation≥3 days,high Sequential Organ Failure Assessment(SOFA)score,high Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,elevated eNAMPT and sDR5 levels were identified as independent risk fac-tors for mortality in SA-ARDS patients,while high oxygenation index was an independent protective factor[OR(95％CI)=1221(1.028-1.449),3.111(1.207-8.020),1.270(1.064-1.517),1.093(1.025-1.167),1.104(1.054-1.157),1.030(1.015-1.046),0.989(0.982-0.996)].The area under the curve(AUC)for serum eNAMPT,sDR5 levels,and their combined evaluation in predic-ting mortality in SA-ARDS patients were 0.794,0.780,and 0.877,respectively,with the combined assessment being superior to the individual assessments of eNAMPT or sDR5(Z/P=2.150/0.032,2 273/0.023).Conclusion Elevated serum eNAMPT and sDR5 levels in SA-ARDS patients are closely associated with the severity of the condition and mortality.The combined evaluation of serum eNAMPT and sDR5 levels has a higher efficacy in predicting mortality in SA-ARDS patients.