The relationship between the changes in peripheral blood ferroptosis indices and the severity of condition in the patients with bloodstream infections

Wang Meng; Liu Lijuan; Yan Tao; Gong Zhen; Chu Wenwen; Zhou Qiang; Liu Zhou

doi:10.3969/j.issn.1002-1949.2024.03.003

Abstract：Objective To analyze the relationship of iron metabolism indices and ferroptosis genes differentially expressed in peripheral blood with disease severity in the patients with bloodstream infections.Methods A total of 98 patients with bloodstream infections in the Second Hospital of Anhui Medical University from August 2022 to May 2023 were chosen as research subjects,and were divided into two groups based on whether or not sepsis occurred:non-sepsis group(n =51)and sepsis group(n = 47).Furthermore,20 healthy persons were chosen as the control group;sepsis patients were divided into general sepsis group(n =18)and sepsis shock group(n =29)according to the severity of the condition.Serum iron metabolism indices,hepcidin,and ceruloplasmin levels were compared in the three groups 48 hours after admission,and real-time quantitative polymerase chain reaction(RT-qPCR)was used to detect genes related to ferroptosis,such as glutathione peroxidase 4(GPX4),heme oxygenase-1(HO-1)and heat shock protein B1(HSPB1).Results The study comprised 98 individuals who had monospecific bacterial bloodstream infections,and a total of 98 strains of pathogenic bacteria were isolated,including 63(64.29%)gram-negative bacteria,30(30.61%)gram-positive bacteria,and 5(5.1%)fungi;patients in the sepsis group mainly had gram-negative bacterial infections,and there were significant differences between the non-sepsis group and the sepsis(P<0.05).There were significant differences in serum iron,ferritin,transferrin,total iron binding capacity,hepcidin,and ceruloplasmin levels among the three groups(P<0.05),the mRNA expression of ferroptosis genes GPX4,HO-1 and HSPB1 was significantly different in general(P<0.05).Ferritin,hepcidin,ceruloplasmin levels,and the ferroptosis-related genes HO-1 and HSPB1 mRNA levels were all significantly higher in the sepsis group than in the non-sepsis group and the control group(P<0.05),whereas GPX4 mRNA levels were significantly lower than in the non-sepsis group and the control group(P<0.05).Similarly,ferritin,hepcidin,ceruloplasmin levels,and the HO-1 and HSPB1 mRNA levels were significantly higher in the sepsis shock group compared to the general sepsis group(P<0.05),while GPX4 mRNA expression was significantly lower(P<0.05).Serum levels of ferritin,hepcidin,and ceruloplasmin were positively correlated with the severity of sepsis(P<0.05).Conclusions The expression levels of iron metabolism-related proteins hepcidin,transferrin and ceruloplasmin,and ferroptosis-related genes GPX4,HO-1 and HSPB1 mRNA are directly associated with the occurrence and development of sepsis in bloodstream infection,and the exact mechanism needs further study.