Clinical value of full-length tryptophanyl-tRNA synthetase for sepsis detection in critically ill patients — A retrospective clinical assessment

Ji Soo Choi,Bo Ra Yoon,Ju Hye Shin,Su Hwan Lee,Ah Young Leem,Moo Suk Park,Young Sam Kim,Kyung Soo Chung

doi:10.1016/j.ijid.2020.05.105

Abstract

ObjectivesRelated innate immune system activation and diagnostic factors of sepsis are not fully understood. The aim of this study was to analyze the clinical value of full-length tryptophanyl-tRNA synthetase (WRS) induced through inflammatory stimuli for the detection of sepsis and prediction of mortality in critically ill patients. MethodsThis was a retrospective analysis of blood samples collected prospectively from patients in the medical intensive care unit (ICU) at Yonsei University College of Medicine, from March 2015 to June 2018. The ability of WRS to detect sepsis and predict mortality were compared to those of procalcitonin (PCT), C-reactive protein (CRP), and interleukin 6 (IL-6), and with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. ResultsA total of 241 study patients were enrolled, of whom 190 (78.8%) had been diagnosed with sepsis on ICU admission. The areas under the receiver operating characteristics curves (AUROCs) for sepsis discrimination with WRS, PCT, CRP, and IL-6 levels, and SOFA and APACHE II scores were 0.864, 0.727, 0.625, 0.651, 0.840, and 0.754, respectively. The prediction of 28-day mortality in patients with sepsis using WRS levels was possible and non-inferior to that with the SOFA score. ConclusionsWRS secreted early in sepsis may be useful not only for the early detection of sepsis, but also for the prediction of mortality in critically ill patients.

Highlights

Innate immunity is activated through the interaction between exogenous molecules, such as pathogen-associated molecular patterns, and pattern-recognition receptors, such as toll-like receptors and C-type leptin receptors (Akira et al, 2006; Kumar et al, 2011; Wiersinga et al, 2014)
Full-length tryptophanyl-tRNA synthetase (WRS), which is present in human monocyte cytoplasm, is an important housekeeping enzyme that participates in the translation
This study was a retrospective analysis of prospectively collected blood samples from patients who had been admitted to the medical intensive care unit (ICU) at Yonsei University College of Medicine from March 2015 to June 2018

Summary

Introduction

Innate immunity is activated through the interaction between exogenous molecules, such as pathogen-associated molecular patterns, and pattern-recognition receptors, such as toll-like receptors and C-type leptin receptors (Akira et al, 2006; Kumar et al, 2011; Wiersinga et al, 2014). Whether sepsis has been caused by an infection is still determined based on a clinician’s opinion (Klimpel et al, 2019). Markers such as procalcitonin (PCT) and C-reactive protein (CRP) are used to determine infection (Cui et al, 2019), these markers are limited in that they cannot detect fungal and viral infections (Vijayan et al, 2017; Wu et al, 2019). A biomarker is needed to reflect the infection-related immune response, including that in cases of bacterial, fungal, and viral infections, and to predict mortality while meeting the new Sepsis-3 definition

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Results