Decoy Receptor 3 as a prognostic biomarker for sepsis and septic shock according to the Sepsis-3 definitions

Long Chen ^1* Xiao Lin ² Xing Yu ² Chunxia Yang ² Rui Li ¹ Qingqing Guo ² Jingshi Shi ² Xiuyu Liao ² Xiaoli Chen ² Zengyi Ma ¹ Jiandong Lin ²

• ¹ Huashan Hospital, Fudan University, Shanghai, China
• ² First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China

ObjectivesThe present study was conducted to reappraise the prognostic value of Decoy Receptor 3 (DcR3) for patients with sepsis and septic shock according to the latest Sepsis-3 definitions.MethodsSubjects suffering from sepsis or septic shock were enrolled within 6 hours of admission. The Sequential Organ Failure Assessment (SOFA) score, and plasma levels of DcR3, C-reactive protein, procalcitonin and interleukin-6 were measured. Group comparisons were made based on the survival status on Day 28 after onset. Predictors of mortality were assessed using the Cox proportional hazard models, and survival curves were plotted with the Kaplan-Meier method. Discriminative performances of single and combined indicators were evaluated via the areas under receiver operating characteristic curves.ResultsAmong 143 eligible sepsis cases, 77 developed septic shock, and the 28-day mortality rates were 32.2% and 45.5%, respectively. Regardless of the population (all sepsis or septic shock), non-survivors exhibited significantly higher DcR3 levels compared to survivors (median 4.19 vs. 2.64 ng/mL, and 4.37 vs. 3.18 ng/mL, respectively; p < 0.001 and p = 0.002, respectively). DcR3 levels were most correlated with organ dysfunction presented by SOFA scores (correlation coefficient = 0.347 and 0.308, respectively; p = 0.001 and 0.016, respectively), but did not differ among the various pathogenic microbes of infection. Multivariate Cox regression identified DcR3 as an independent predictor of mortality (hazard ratio [95% confidence interval] 1.570 [1.048-2.352] and 1.828 [1.047-3.194], respectively; p = 0.029 and 0.034, respectively). Kaplan-Meier analysis showed that elevated DcR3 concentrations were associated with significantly lower survival rates (p = 0.001 and 0.013, respectively). The areas under receiver operating characteristic curves of DcR3 alone for predicting outcome were superior to that of the other three biomarkers (0.731 and 0.711, respectively), and could be further improved when coupled with SOFA scores (0.803 and 0.784, respectively).ConclusionsDcR3 is a valuable prognostic biomarker for sepsis and septic shock, offering the potential to predict 28-day mortality in clinical settings.