AUTHOR=Xu Yunyu , Li Nanyang , Gao Jiamin , Shang Da , Zhang Min , Mao Xiaoyi , Chen Ruiying , Zheng Jianming , Shan Ying , Chen Mingquan , Xie Qionghong , Hao Chuan-Ming 

TITLE=Elevated Serum Tenascin-C Predicts Mortality in Critically Ill Patients With Multiple Organ Dysfunction

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.759273

DOI=10.3389/fmed.2021.759273

ISSN=2296-858X

ABSTRACT=Background: Multiple organ dysfunction is a complex and lethal clinical feature with heterogeneous causes and usually characterized by tissue injury of multiple organs. Tenascin-C (TNC) is a matricellular protein that is rarely expressed in most of adult tissues, but re-induced following injury. The aim of this study was to evaluate serum TNC in predicting all-cause mortality in critically ill patients with multiple organ dysfunction.
Methods: Critically ill patients with at least two organs dysfunction and an increase of SOFA score ≥ 2 points within 7 days were enrolled into two independent cohorts. Their serum samples at the first 24 hours after enrollment were collected and subjected to TNC measurement using enzyme-linked immunosorbent assay (ELISA). The association between serum TNC level and 28-day all-cause mortality was investigated, and then the predictive value of serum TNC was analyzed.
Results: A total of 110 patients with median age of 64 (53, 73) were enrolled in the emergency cohort. Compared to the survivors, serum TNC in the non-survivors was significantly higher (467.7ng/ml vs. 197.5ng/ml, p<0.001). Multivariate logistic regression analysis revealed that the association between serum TNC and 28-day all-cause mortality was independent of sepsis or critical illness scores such as SOFA, APACHE Ⅱ and SAPS Ⅱ respectively (p<0.001 for each). The area under receiver operating characteristic curve of serum TNC for predicting all-cause mortality was 0.803 (0.717-0.888) (p<0.001), similar with SOFA 0.808 (0.725-0.891), APACHE Ⅱ 0.762 (0.667-0.857) and SAPS Ⅱ 0.779 (0.685-0.872). The optimal cut-off value of serum TNC was 298.2ng/ml. Kaplan-Meier analysis showed that the survival of patients with serum TNC ≥300ng/ml was significantly worse than that of patients with serum TNC <300ng/ml. This result was validated in the inpatient cohort. The sensitivity and specificity of serum TNC ≥300ng/ml for predicting mortality was 74.3% and 74.7% in the emergency cohort, and 63.0% and 70.1% in the inpatient cohort. 
Conclusion: Serum TNC was associated with all-cause mortality in critically ill patients with multiple organ dysfunction, and would be used as a prognostic tool for predicting all-cause mortality in this population.