Objective To investigate the correlations of the expression levels of serum silencing information regulatory factor 2-related enzyme 1 (SIRT1), endothelial cell-specific molecule-1 (ESM-1), and fibroblast growth factor-21 (FGF21) with therapeutic outcome in patients with sepsis-related acute respiratory distress syndrome (ARDS).

Methods A total of 140 patients with sepsis-related ARDS were selected and divided into good outcome group (n=96) and poor outcome group (n=44) according to the therapeutic outcome. The levels of serum SIRT1, ESM-1 and FGF21 were compared between the two groups, and the correlations of serum SIRT1, ESM-1 and FGF21 with the severity of the disease and therapeutic outcome were analyzed. The predictive values of serum SIRT1, ESM-1 and FGF21 for therapeutic outcome were evaluated.

Results The serum SIRT1 level in the poor outcome group was significantly lower, while the levels of ESM-1 and FGF21 were significantly higher than those in the good outcome group (P < 0.05). The serum SIRT1 level showed a significant gradual downward trend in mild, moderate, and severe patients, while the ESM-1 and FGF21 levels showed a significant gradual upward trend in mild, moderate, and severe patients (P < 0.05). Spearman correlation analysis showed that serum SIRT1 was significantly negatively correlated with disease severity, while ESM-1 and FGF21 were significantly positively correlated with disease severity (P < 0.05). Partial correlation analysis showed that serum SIRT1, ESM-1 and FGF21 were significantly correlated with the therapeutic outcome of ARDS patients with sepsis (P < 0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of serum SIRT1, ESM-1 and FGF21 for predicting the treatment outcome of sepsis-related ARDS patients was 0.742, 0.838 and 0.796 respectively, with sensitivities of 77.27%, 77.27% and 70.45%, and specificities of 64.58%, 81.25% and 87.50%. The AUC of the combination of three indexes for predicting the therapeutic outcome of sepsis-related ARDS patients was 0.939, with a sensitivity of 88.64% and a specificity of 83.33%, which was significantly higher than the predictive value of the three indexes alone (P < 0.05).

Conclusion The levels of SIRT1, ESM-1 and FGF21 in the serum of sepsis-related ARDS patients are significantly correlated with the severity of the disease and the therapeutic outcome, and have the abilitis to independently predict the therapeutic outcome. The combined predictive value is even higher.