Marker Of Sepsis Research Articles

Clinical Profile and Pediatric Patterns in Predicting Sepsis Among Febrile Inpatients at an Indian Hospital: A Prospective Observational Study

Background: Sepsis is a global perpetrator of pediatric morbidity and mortality. This research aims to analyze the clinical profile of febrile pediatric patients with a risk of sepsis to study underlying patterns involved and understand clinician perspectives to ensure diagnostic accuracy and assess the management and outcomes. Methods: In this prospective cross sectional descriptive study 300 febrile inpatients of 1 month to 13 years of age with one or more sepsis warning signs were examined. Patient factors affecting progression towards sepsis were analyzed, along with age-related patterns of tachycardia and tachypnea. Risk of developing sepsis was compared with degree of elevation in TLC, patient admission and outcome on discharge. The study also extended towards segregating most relied markers of sepsis by comparing prevalence among various risk groups. Results: Factors such as male gender, infancy, and incomplete vaccination status were found to increase the chances of developing sepsis. Diverse diagnoses heightened sepsis likelihood to varying extents. Tachycardia and tachypnea followed a pattern of manifesting most among infants. The study demonstrated a direct link between rising sepsis risk and elevating TLC levels. Quantification of PS6 interventions demonstrated that adrenaline was the most commonly used ionotrope and IVF DNS was the most used isotonic fluid. Conclusion: The unpredictable nature of pediatric sepsis can be tackled by an effective understanding of the patterns by which it manifests. Early detection of sepsis relies on pediatric patterns and established symptomatology approved commonly among clinicians which demands constant evaluation to ensure appropriateness and diagnostic consistency. Keywords: Biomarkers, Acute febrile illness, Pediatric Intensive care Unit (PICU), Neonatal intensive care unit (NICU), SIRS

Enhancing neonatal sepsis detection: A comparative analysis of interleukin-6 and the BacT/ALERT blood culture system

One of the main causes of newborn mortality is neonatal sepsis, which has to be diagnosed quickly and precisely. Although the Bact/ALERT method for blood culture is commonly used, it is often slow, for early identification of sepsis, interleukin-6 (IL-6) provides a quicker substitute. : This study evaluates how well the BacT/ALERT system and IL-6 diagnose newborn sepsis, aiming to determine the most reliable and timely method for improving neonatal outcomes. A clinician at the National Institute of Medical Sciences & Research who admitted neonates to the neonatal intensive care unit (NICU) suspected 120 newborns of having sepsis. The inclusion criteria were satisfied by newborns between the ages of 0 and 28 days who showed clinical signs of sepsis. Exclusion criteria included infants with congenital anomalies or those who had received antibiotics before sampling. In this study of 120 neonates, IL-6 levels were elevated in 45% of the cases, with a sensitivity of 100%, specificity 86.84%, PPV 81.48% and NPV 100% for. 36.67% of samples had bacterial growth identified by the BacT/ALERT system. In just three hours, IL-6 produced results, which was far quicker than the BacT/ALERT method. IL-6 is a rapid, sensitive marker for neonatal sepsis, offering faster diagnosis than BacT/ALERT. Combining both methods may improve early detection and treatment outcomes. IL-6 offers rapid, high-sensitivity sepsis detection compared to BacT/ALERT, which, despite being slower, is crucial for pathogen identification. Combining both methods could enhance early diagnosis and treatment.

Clinical Value of MiR-191-5p in Patients with Sepsis and Its Regulatory Role in Sepsis-Related Left Ventricular Systolic Dysfunction.

In this study, the expression and clinical value of miR-191-5p in sepsis and sepsis-induced left ventricular systolic dysfunction are explored, and the effects of miR-191-5p on inflammation and cardiac function in rats are examined by establishing a septic rat model.The expression level of serum miR-191-5p was detected via reverse transcription quantitative polymerase chain reaction. To evaluate the diagnostic efficacy of miR-191-5p in sepsis, the receiver operator characteristic curve was established. To evaluate the relationship between the expression level of miR-191-5p and the clinical biochemical indicators, Pearson analysis was employed. Multivariate logistic regression was utilized to analyze the risk factors of cardiac dysfunction. The rat model was reproduced via cecal ligation and puncture. FDP-1 HRV-BRS analysis system was utilized to detect the cardiac function. To determine the myocardial enzymes and cytokines, blood samples from rats were collected.Compared with healthy individuals. the expression of miR-191-5p in the serum of sepsis patients was lower, and the miR-191-5p level in the serum of patients with cardiac dysfunction was lower than in that of those with normal cardiac function. MiR-191-5p demonstrated good accuracy in distinguishing cardiac dysfunction from normal cardiac function. Decreased levels of miR-191-5p are a risk factor for developing normal cardiac function in sepsis into cardiac dysfunction. In septic rats, upregulating the miR-191-5p expression by injecting miR-191-5p agomir can significantly enhance cardiac function and inhibit the inflammatory response.MiR-191-5p has shown clinical value in distinguishing patients with sepsis associated with left ventricular systolic dysfunction and has the potential as a diagnostic marker for sepsis.

Prenatal Ultrasound Markers of Adverse Perinatal Outcomes in Newborns With Simple and Complex Gastroschisis.

The aim of this study was to compare prenatal ultrasound markers and perinatal outcomes in newborns with simple and complex gastroschisis. A retrospective cohort study was performed on pregnant women with gastroschisis fetuses and their respective newborns between 2009 and 2019. Binary logistic regression was used to determine the best prenatal ultrasound markers of complex gastroschisis and adverse perinatal outcomes. After delivery, 36 gastroschisis were classified as simple and 10 as complex. Newborns with complex gastroschisis had a higher prevalence of early neonatal death compared to newborns with simple gastroschisis (30.0% vs. 2.8%, p = 0.007). The abdominal wall defect diameter became a significant prenatal ultrasound marker of neonatal sepsis [X2: 6.31 (1), OR:0.92, CI 95% (0.85-0.98), p = 0.020]. The presence of complex gastroschisis [X2: 7.33 (1), OR: 23.25, CI 95% 1.92-280.77, p = 0.013] was the only significant predictor of early neonatal death, and the presence of complex gastroschisis increased the risk of early neonatal death by 23.25 times. There was no significant effect of the type of gastroschisis in relation to gestational age, amniotic fluid index, intra-abdominal intestinal dilation, extra-abdominal intestinal dilation, and thickness of the intestine diameter. Abdominal wall defect diameter was a significant prenatal ultrasound marker of adverse perinatal outcomes in newborns with simple and complex gastroschisis. Complex gastroschisis was a significant predictor of early neonatal death.

Evaluating the Diagnostic and Prognostic Value of Interleukin-6 (IL-6) and Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1) in Systemic Inflammatory Response Syndrome (SIRS) and Sepsis in Adults.

Sepsis and systemic inflammatory response syndrome (SIRS) are significant concerns in intensive care units and contribute significantly to patient mortality. Traditional diagnostic markers such as C-reactive protein (CRP) and procalcitonin (PCT) often lack the sensitivity and specificity needed for early diagnosis and prognosis. Consequently, more reliable biomarkers are needed. This study aimed to evaluate interleukin-6 (IL-6) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) as potential biomarkers to improve diagnostic and prognostic capabilities in sepsis and SIRS. The study comprised 64 patients diagnosed with sepsis and SIRS, admitted to the Critical Care Department of the First University Clinic (Tbilisi, Georgia). Changes in the levels of CRP, PCT, IL-6,sTREM-1, and lactate were monitored over a five-day observation period, with measurements taken on days 0, 1, 2, 3, and 5. We found a significant logarithmic relationship between sTREM-1 levels and Acute Physiology and Chronic Health Evaluation II (APACHE II)scores (r = 0.922, p < 0.001), suggesting that sTREM-1 could serve as a valuable biomarker for early risk stratification in sepsis. Furthermore, sTREM-1 exhibited strong correlations with IL-6 and lactate levels, underscoring its potential as a predictor of disease severity. While CRP and PCT were more useful in tracking disease progression over time, their baseline levels were less predictive of early outcomes. Our findings highlight the potential of sTREM-1, IL-6, and lactate as early diagnostic and prognostic markers in sepsis, where sTREM-1 is a critical biomarker for identifying high-risk patients. Further studies with larger cohorts are required to validate these results and explore the sTREM-1 clinical utility in guiding therapeutic interventions in sepsis management.

SPP1 is a plasma biomarker associated with the dia gnosis and prediction of prognosis in sepsis

In this study, peripheral whole blood samples from 22 hospitalized patients and 10 healthy individuals were analyzed using a combination of Data Independent Acquisition (DIA) and Enzyme-Linked Immunosorbent Assay (ELISA) techniques to identify differentially expressed proteins (DEPs) in sepsis patients’ plasma. The aim was to provide accurate and detailed biomarkers, such as SPP1, for determining the pathological stages of sepsis. SPP1, known as osteopontin1 is a pleiotropic protein with a wide distribution and multifunctional effects. Its protein expression is associated with inflammatory changes, including variations in expression levels in infectious diseases, allergic diseases, and situations involving tissue damage. The registration number was ChiCTR1900021261.The full date of first registration year is 2018. In the affiliated hospital of southwest medical university, 22 sepsis patients were hospitalized from January 2019 to September 2020 and 10 normal healthy individuals were selected for DIA-based quantitative proteomics analysis. In addition to gene ontology analysis and Kyoto Encyclopedia of genes and genomes analysis, enrichment analysis of data was performed and target protein network was screened through joint protein–protein interaction and visualization techniques. The selected protein targets were then validated by Elisa kit. The software was used to analyze the differences comparing the control group to the sepsis group and the sepsis group, as well as between sepsis survivals and non-survivals, and a ROC curve was drawn to evaluate the diagnostic value and prognostic effect of the method of the corresponding target proteins. A total of 174 DEPs were screened by bioinformatics analysis. An analysis of go pathway enrichment revealed the following: These proteins were mainly involved in biological processes among them are the inflammation response, the metabolism of extracellular matrix, the secretion of cell secretions, the activation of cells, and the immune response. According to the Kegg pathway analysis, they were mainly involved in complement cascade polymerization, extracellular protease and glycosylase activation, protein synthesis process, biotin metabolism, leukocyte transmembrane migration, bacterial infection and phagosome formation. SPP1 was identified as a possible plasma biomarker and was therefore further validated using Elisa. As a result of experiments, it has been demonstrated that level in sepsis patients is significantly compared to the normal control group and the level is also higher in non-survivals of sepsis. The ROC curve can be used to see that it can diagnose sepsis more accurately and improve prognostic ability prediction. Cell experiments confirm that SPP1 is highly expressed in sepsis. There is a significant difference in the levels of SPP1 protein between the normal group and the sepsis group; it not only has good diagnostic significance for sepsis, but also provides corresponding reference value for patient prognosis; Therefore, it is more likely to become a biological marker of sepsis over time.

Azithromycin in severe malaria bacterial co-infection in African children (TABS-PKPD): a phase II randomised controlled trial

BackgroundAfrican children with severe malaria are at increased risk of non-typhoidal salmonellae co-infection. Broad-spectrum antibiotics are recommended by guidelines but the optimal class and dose have not been established. We investigated the optimal dose of oral dispersible azithromycin and whether simple clinical criteria and point-of-care biomarkers could target antibiotics to those at greatest risk of bacterial co-infection.MethodsWe conducted a phase I/II trial in Ugandan children with severe malaria comparing a 5-day course of azithromycin: 10, 15 and 20 mg/kg of azithromycin (prescribed by weight bands) spanning the dose-range effective for other salmonellae infection. We generated relevant pharmacokinetic (PK) data by sparse sampling during dosing intervals and investigated associations between azithromycin exposure and potential mechanisms (PK-pharmacodynamics) using change in C-reactive protein (CRP), a putative marker of sepsis, at 72 h (continuous) and microbiological cure (7-day) (binary), alone and as a composite with 7-day and 90-day survival. To assess whether clinical or biomarkers could identify those at risk of sepsis, a non-severe malaria control was concurrently enrolled.ResultsBetween January 2020 and January 2022, 105 cases were randomised azithromycin doses: 35 to 10 mg/kg, 35 to 15 mg/kg and 35 to 20 mg/kg. Fifty non-severe malaria controls were concurrently enrolled. CRP reduced in all arms by 72 h with a mean reduction of 65.8 mg/L (95% CI 57.1, 74.5) in the 10 mg/kg arm, 64.8 mg/L (95% CI 56.5, 73.1; p = 0.87) in the 20 mg/kg arm and a smaller reduction 51.2 mg/L (95% CI 42.9, 59.5; p = 0.02) in the 15 mg/kg arm. Microbiological cure alone outcome was not analysed as only one pathogen was found among cases. Three events contributed to the composite outcome of 7-day survival and microbiological cure, with no events in the 15 mg/kg arm. The odds ratio comparing 20 vs 10 mg/kg was 0.50 (95% CI 0.04, 5.79); p = 0.58. Due to the low number of pathogens identified, it was not possible to identify better methods for targeting antibiotics including both the cases and controls.ConclusionsWe found no evidence for an association between systemic azithromycin exposure and reduction in CRP. Further work is needed to better identify children at highest risk from bacterial co-infection.Trial registrationISRCTN49726849 (registered on 27th October 2017).

Assessment of sestrin 2 as a sepsis marker and predictor of disease severity

Introduction Sestrin 2 is considered a stress-inducible antioxidant protein. This study was aimed to evaluate sestrin 2 in subjects with sepsis, and its correlation with clinical severity and mortality. Methods Sepsis and control group patients were followed from admission to discharge. A blood sample was taken at admission for determination of serum sestrin 2 level. Results Of the total 42 patients with sepsis, there were 25 females and the mean age was 74.9 years. The sestrin 2 levels were significantly higher in the sepsis group. The optimum sestrin 2 cut-off point of ≥3.13 ng/mL had 95.2% sensitivity and 71.4% specificity for sepsis (p < .001). Sestrin 2 levels were higher in patients who needed renal replacement therapy (p = .018), patients who needed vasopressor therapy (p = .001) and patients with organ dysfunction (p = .002). The sestrin 2 level was significantly correlated with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Nutrition Risk in the Critically Ill (NUTRIC) Score, C-reactive protein and albumin. Sestrin 2 levels were not associated with 30 d mortality in sepsis patients. Conclusions Sestrin 2 was significantly higher in the sepsis patients and associated with sepsis related adverse clinical outcomes. These results provided information concerning the clinical utility of sestrin 2.

Early detection of neonatal sepsis and reduction of overall antibiotic exposure: Towards precision medicine

Infections claim the lives of over half a million newborns annually and expose survivors to the risk of lifelong disability. The challenge to clinicians is to identify newborns with invasive infections rapidly, promptly initiate antimicrobial treatment, and take measures to prevent and treat organ dysfunction. Moreover, excessive antibiotic use is a global public health problem. Despite considerable research on clinical and laboratory markers of neonatal sepsis, the effective translation into clinical practice remains limited. There is no single clinical or laboratory marker, nor any combination of markers that definitively confirms or rules out neonatal sepsis. The interpretation of these markers should take into account their diagnostic value for a given patient, along with their added value to the clinical decision-making process. The digitalization of health care systems, combined with increased computational power and advances in machine learning, offers the possibility of developing accurate predictive algorithms for early detection of neonatal sepsis.

A prospective observational study of neutrophil CD64 as a diagnostic marker in neonatal sepsis

A prospective observational study of neutrophil CD64 as a diagnostic marker in neonatal sepsis

Bioactive Adrenomedullin in Dogs with Sepsis and Septic Shock: A Prospective, Case-Control Study.

Sepsis and septic shock are leading causes of morbidity and mortality in both humans and dogs, and early diagnosis is crucial for improving outcomes. This study aimed to evaluate bioactive adrenomedullin (bio-ADM) concentrations in dogs with septic shock (n = 25), dogs with sepsis without evidence of shock (n = 25), and healthy control dogs (n = 25). Plasma bio-ADM concentrations were measured using a human sandwich enzyme-linked immunosorbent assay and reported as median (interquartile range). Plasma bio-ADM concentrations were significantly higher in both septic groups compared to the healthy controls (all <22.4 pg/mL), but not significantly different between the septic shock (75.0 [28.7-115.0] pg/mL) and sepsis (30.7 [22.4-79.7] pg/mL) groups. Dogs with higher illness severity scores had significantly higher bio-ADM concentrations (93.1 [32.2-122.0] pg/mL) than those with lower scores (29.8 [22.4-71.2] pg/mL). However, bio-ADM concentrations did not differ between survivors (33.0 [22.7-76.7] pg/mL) and non-survivors (74.7 [26.1-123.2] pg/mL). Measurement of bio-ADM is a potential marker for canine sepsis, but not for the identification of septic shock, and may provide information on disease severity. Further studies, including those on non-infectious inflammatory conditions, are necessary to better understand the diagnostic utility of bio-ADM measurement and its potential role as a marker of treatment response in dogs with sepsis.

Exploring the circulating metabolome of sepsis: metabolomic and lipidomic profiles sampled in the ambulance

BackgroundSepsis is defined as a dysfunctional host response to infection. The diverse clinical presentations of sepsis pose diagnostic challenges and there is a demand for enhanced diagnostic markers for sepsis as well as an understanding of the underlying pathological mechanisms involved in sepsis. From this perspective, metabolomics has emerged as a potentially valuable tool for aiding in the early identification of sepsis that could highlight key metabolic pathways and underlying pathological mechanisms.ObjectiveThe aim of this investigation is to explore the early metabolomic and lipidomic profiles in a prospective cohort where plasma samples (n = 138) were obtained during ambulance transport among patients with infection according to clinical judgement who subsequently developed sepsis, patients who developed non-septic infection, and symptomatic controls without an infection.MethodsMultiplatform metabolomics and lipidomics were performed using UHPLC–MS/MS and UHPLC–QTOFMS. Uni- and multivariable analysis were used to identify metabolite profiles in sepsis vs symptomatic control and sepsis vs non-septic infection.ResultsUnivariable analysis disclosed that out of the 457 annotated metabolites measured across three different platforms, 23 polar, 27 semipolar metabolites and 133 molecular lipids exhibited significant differences between patients who developed sepsis and symptomatic controls following correction for multiple testing. Furthermore, 84 metabolites remained significantly different between sepsis and symptomatic controls following adjustment for age, sex, and Charlson comorbidity score. Notably, no significant differences were identified in metabolites levels when comparing patients with sepsis and non-septic infection in univariable and multivariable analyses.ConclusionOverall, we found that the metabolome, including the lipidome, was decreased in patients experiencing infection and sepsis, with no significant differences between the two conditions. This finding indicates that the observed metabolic profiles are shared between both infection and sepsis, rather than being exclusive to sepsis alone.

Copeptin as an inflammatory marker in diagnosis and prognosis of neonatal sepsis

BackgroundCopeptin is an immediate biomarker of individual stress response; many life-threatening diseases are causing a high elevation of its concentration in plasma, such as myocardial infarction and cardiovascular shock. Moreover, copeptin is a promising marker in sepsis. We aimed to evaluate copeptin as a diagnostic and prognostic marker in neonatal sepsis for the early initiation of appropriate therapy and the prediction of mortality. A prospective case-control study involved 237 neonates (165 cases had neonatal sepsis, and 72 served as controls). Cases were admitted to the neonatal intensive care unit (NICU) and followed up for symptoms and signs of sepsis confirmed by laboratory data: complete blood count (CBC), c-reactive protein (CRP), and cultures. Serum copeptin level by the enzyme-linked immunosorbent assay (ELISA) was measured for all included neonates. We observed that the copeptin level was significantly higher in cases than control (3.51 ± 1.4, 1.61 ± 0.51 pmol/liter, respectively). The cut-off value of copeptin at which we can discriminate between cases and controls was above 2.065 pmol/liter. Among cases, copeptin was higher in early-onset sepsis (EOS) than late-onset sepsis (LOS) neonates, and there was a significant correlation between its level and all the following: age at admission, birth weight, gestational age, history of perinatal asphyxia, maternal chorioamnionitis, and premature rupture of membrane (PROM). Also, copeptin was strongly associated with CRP level and the poor prognosis of patients. Copeptin can predict the death of cases at a cut-off value above 2.995 pmol/liter.ConclusionSerum copeptin level can be used as a diagnostic and prognostic marker in neonatal sepsis.

Evaluation of sRAGE as a New Diagnostic and Prognostic Marker of Sepsis and Septic Shock Cases on Critically Ill Pediatric Patients

Abstract Background Serum sRAGE is a soluble isoform of a receptor for advanced glycation end products in different stages of sepsis. The present study will investigate the possible use of sRAGE as a diagnostic and prognostic marker of sepsis and septic shock in pediatric patients. Objective To study the role of sRAGE as a potential diagnostic and prognostic marker in sepsis and septic shock in pediatric intensive care unit. Patients and Methods This was a case control study that was conducted at Pediatric ICU, Ain Shams University Hospitals. This Studied were divided into 3 groups: 1/ Sepsis group (20 patients). 2/ Septic shock group (20 patients). 3/ healthy control group (40 child). Results In Sepsis cases, ROC curve analysis proved good discriminating power of the Serum RAGE between Non Survivor group and Survivor group where Area under the ROC curve (AUC) = 0.760 with (95% Confidence interval 0.52–0.92); p &amp;lt; 0.001. Cutoff point &amp;gt;270 with sensitivity= 80% and specificity=73.3%. In Septic Shock Cases, ROC curve analysis proved good discriminating power of the Serum RAGE between Non Survivor group and Survivor group where Area under the ROC curve (AUC) = 0.955 with (95% Confidence interval 0.76–0.99); p &amp;lt; 0.001. Cutoff point &amp;gt;310.9 with sensitivity= 90% and specificity=91%. Conclusion Our study suggests that sRAGE may serve as a valuable biomarker for assessing the severity and prognosis of sepsis and septic shock in pediatric patients, although further research with a larger sample size is warranted to validate these findings.

The Value of Complete Blood Count Indices for Early Detection of Sepsis in Preterm Infants

Abstract Background Early-onset sepsis (EOS) remains a common and serious problem in neonates. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are easily accessible biomarkers that have been reported to have meaningful correlations with inflammatory markers. Objectives We aimed to evaluate the NLR, PLR and systemic immune-inflammation (SII) as a diagnostic tests for early detection of EOS. Patients and Methods This study was carried out on 100 preterm infants at the Neonatal Intensive Care Unit (NICU) of Ain Shams University Children’s Hospital. They were divided into two groups: Group A (patient group) which included 45 preterm, suffering from EOS and group B (controls group) which included 55 healthy preterm. History-taking, complete clinical examination, blood culture, complete blood count (CBC), C-reactive protein (CRP), NLR, PLR and SII were done. Results Patients group (high CRP, Rodwell Score positive, positive blood cultures) had significantly higher NLR, PLR, and SII at first and third day of life compared with the controls group(negative CRP, Rodwell Score non sepsis and negative blood cultures). NLR of 1.9 was determined as the predictive cutoff value of EOS (sensitivity 91.11%; specificity 92.73%). A PLR of 53.79 was determined as the predictive cutoff value of neonatal EOS (sensitivity 93.33%; specificity 43.64%). A SII of 333.97 was determined as the predictive cutoff value of neonatal EOS (sensitivity 97.98%; specificity 90.91%). Conclusion NLR, PLR and SII had high sensitivity and specificity as diagnostic markers for earlyonset neonatal sepsis.

199 Evaluation of the Diagnostic Accuracy of Exhaled Nitric Oxide as a Marker of Infection and Sepsis in Emergency Department Patients

199 Evaluation of the Diagnostic Accuracy of Exhaled Nitric Oxide as a Marker of Infection and Sepsis in Emergency Department Patients

Association between red blood cell distribution width and 30-day mortality in critically ill septic patients: a propensity score-matched study

BackgroundSepsis is the leading cause of death worldwide, and a number of biomarkers have been developed for early mortality risk stratification. Red blood cell distribution width (RDW) is a routinely available hematological data and has been found to be associated with mortality in a number of diseases; therefore, we aim to address the association between RDW and mortality in critically ill patients with sepsis.MethodsWe analyzed data of critically ill adult patients with sepsis on the TriNetX platform, excluding those with hematologic malignancies, thalassemia, and iron deficiency anemia. Propensity score-matching (PSM) (1:1) was used to mitigate confounding effects, and hazard ratio (HR) with 95% confidence (CI) was calculated to determine the association between RDW and 30-day mortality. We further conducted sensitivity analyses through using distinct cut-points of RDW and severities of sepsis.ResultsA total of 256,387 critically ill septic patients were included in the analysis, and 40.0% of them had RDW equal to or higher than 16%. After PSM, we found that high RDW was associated with an increased 30-day mortality rate (HR: 1.887, 95% CI 1.847–1.928). The associations were consistent using distinct cut-points of RDW, with the strength of association using cut-points of 12%, 14%, 16%, 18% and 20% were 2.098, 2.204, 1.887, 1.809 and 1.932, respectively. Furthermore, we found consistent associations among critically ill septic patients with distinct severities, with the association among those with shock, receiving mechanical ventilation, bacteremia and requirement of hemodialysis being 1.731, 1.735, 2.380 and 1.979, respectively.ConclusionWe found that RDW was associated with 30-day mortality in critically ill septic patients, underscoring the potential as a prognostic marker in sepsis. More studies are needed to explore the underlying mechanisms.

Antimicrobial therapy in newborns: from theory to practice

Currently, there are no uniform accurate statistical data on the development of neonatal sepsis. This critical condition is difficult to diagnose in the early stages due to the lack of reliable markers with high prognostic value, and the use of currently available sepsis markers with high specificity and/or sensitivity is limited to large tertiary level obstetric hospitals. In this regard, as part of the early diagnosis of neonatal sepsis, issues related to amultifactorial assessment of the risk of neonatal sepsis becoming relevant, on the basis of which indications for prescribing therapy for the prevention of this condition will be justified. The most common etiological cause of sepsis is numerous pathogens: bacteria, viruses and fungi. This again leaves difficulties in choosing the right therapeutic tactics, especially within the framework of antibiotic therapy, the protocols of which vary from hospital to hospital not only in our country, but throughout the world. Based on the practice of domestic and foreign colleagues, it is necessary to discuss protocols for the management of patients with such acomplex diagnosis as sepsis.

Predicting Mortality in Sepsis: The Role of Dynamic Biomarker Changes and Clinical Scores-A Retrospective Cohort Study.

The prognostic value of baseline inflammatory markers in sepsis remains controversial, with conflicting evidence regarding their association with mortality. The dynamic changes in these markers over time might offer additional insights into disease progression and patient outcomes. This retrospective observational study included 138 patients with severe infections. The inflammatory biomarkers procalcitonin (PCT), C-reactive protein (CRP), and lactate (LAC) were measured at three time points: upon hospital admission (baseline), approximately 24-48 h after admission (second measurement; M2), and 48-72 h after admission (third measurement; M3). The primary outcome was 30-day mortality. A Mann-Whitney U test was used to compare the biomarker levels between the survivors and non-survivors. A Spearman's correlation was used to assess the relationships between the baseline parameters. A logistic regression and a receiver operating characteristic (ROC) curve analysis were employed to evaluate the prognostic value of the baseline markers and their dynamic changes. The baseline LAC and SOFA score were significantly associated with 30-day mortality. The percentage decrease in PCT, CRP, and LAC from the baseline to M3 emerged as strong predictors of survival, with the ROC curve analysis demonstrating superior discriminatory ability compared to the baseline values. CRP_Delta exhibited the highest AUC (0.903), followed by PCT_Delta (0.843) and LAC_Delta (0.703). The dynamic changes in these inflammatory biomarkers, particularly PCT, CRP, and LAC, offer valuable prognostic information beyond their baseline levels in predicting 30-day mortality in severe infections. These findings highlight the importance of monitoring biomarker trends for early risk stratification and potential treatment guidance.

Platelet Metabolites as Candidate Biomarkers in Sepsis Diagnosis and Management Using the Proposed Explainable Artificial Intelligence Approach.

Background: Sepsis is characterized by an atypical immune response to infection and is a dangerous health problem leading to significant mortality. Current diagnostic methods exhibit insufficient sensitivity and specificity and require the discovery of precise biomarkers for the early diagnosis and treatment of sepsis. Platelets, known for their hemostatic abilities, also play an important role in immunological responses. This study aims to develop a model integrating machine learning and explainable artificial intelligence (XAI) to identify novel platelet metabolomics markers of sepsis. Methods: A total of 39 participants, 25 diagnosed with sepsis and 14 control subjects, were included in the study. The profiles of platelet metabolites were analyzed using quantitative 1H-nuclear magnetic resonance (NMR) technology. Data were processed using the synthetic minority oversampling method (SMOTE)-Tomek to address the issue of class imbalance. In addition, missing data were filled using a technique based on random forests. Three machine learning models, namely extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and kernel tree boosting (KTBoost), were used for sepsis prediction. The models were validated using cross-validation. Clinical annotations of the optimal sepsis prediction model were analyzed using SHapley Additive exPlanations (SHAP), an XAI technique. Results: The results showed that the KTBoost model (0.900 accuracy and 0.943 AUC) achieved better performance than the other models in sepsis diagnosis. SHAP results revealed that metabolites such as carnitine, glutamate, and myo-inositol are important biomarkers in sepsis prediction and intuitively explained the prediction decisions of the model. Conclusion: Platelet metabolites identified by the KTBoost model and XAI have significant potential for the early diagnosis and monitoring of sepsis and improving patient outcomes.