Diagnosing sepsis – The role of laboratory medicine

Fan, Shu-Ling; Miller, Nancy S.; Lee, John; Remick, Daniel G.

doi:10.1016/j.cca.2016.07.002

Cited by 141 publications

(121 citation statements)

References 82 publications

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“…7B). IL-6 levels are increased in patients with infectious complications and are used clinically to provide a quantitative assessment of sepsis severity (42)(43)(44). Additionally, IL-6 levels correlate with the mortality rate in septic patients (45).…”

Section: Elevated Early Life Il-27 Compromises Immunitymentioning

confidence: 99%

Elevated Levels of Interleukin-27 in Early Life Compromise Protective Immunity in a Mouse Model of Gram-Negative Neonatal Sepsis

et al. 2020

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Neonates are at increased risk for bacterial sepsis. We established that the immune-suppressive cytokine interleukin-27 (IL-27) is elevated in neonatal mice. Similarly, human cord blood-derived macrophages express IL-27 genes and secrete more cytokine than macrophages from adults. In the present work, we hypothesized that increased levels of IL-27 predispose neonatal mice to more severe infection during Gram-negative sepsis. Serum IL-27 levels continued to rise during infection. Peripheral tissue analysis revealed systemic IL-27 expression, while myeloid cell profiling identified Gr-1-and F4/80-expressing cells as the most abundant producers of IL-27 during infection. Increased IL-27 levels were consistent with increased mortality that was improved in IL-27 receptor ␣ (IL-27R␣) Ϫ/Ϫ mice that lack a functional IL-27 receptor. Infected IL-27R␣ Ϫ/Ϫ pups also exhibited improved weight gain and reduced morbidity. This was consistent with reduced bacterial burdens and more efficient bacterial killing by Ly6B.2 ϩ myeloid cells and macrophages compared to WT neonates. Live animal imaging further supported a more severe and disseminated infection in WT neonates. This is the first report to describe the impact of elevated early-life IL-27 on the host response in a neonatal infection model while also defining the cell and tissue sources of cytokine. IL-27 is frequently associated with suppressed inflammation. In contrast, our findings demonstrate that IL-27 indirectly promotes an inflammatory cytokine response during neonatal sepsis by directly compromising control of bacteria that drive the inflammatory response. Collectively, our results suggest that IL-27 represents a therapeutic target to limit susceptibility and improve infectious outcomes in neonatal sepsis.

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Section: Elevated Early Life Il-27 Compromises Immunitymentioning

confidence: 99%

Elevated Levels of Interleukin-27 in Early Life Compromise Protective Immunity in a Mouse Model of Gram-Negative Neonatal Sepsis

et al. 2020

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“…Given the limitations of the above-mentioned biochemical markers, a wide variety of new markers related to microbiological products or the host’s inflammatory immune response have been proposed over the last few years 17. However, none of these markers can be recommended as a unique criterion for the diagnosis of sepsis, and experts recommend to use a combination of parameters, that is, infection score.…”

Section: Introductionmentioning

confidence: 99%

Role of leucocytes cell population data in the early detection of sepsis

2017

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AimsThe cell population data (CPD) parameters reported by XN analyser (Sysmex, Kobe, Japan) reflect the size and internal structure of leucocytes. We aimed to assess the clinical utility of these parameters as biomarkers for the early diagnosis of sepsis.MethodsThe study group (G1) included 586 controls (no quantitative or morphological alterations in the complete blood count) and 137 patients diagnosed with sepsis. The reliability of the model was evaluated using a validation group (G2) of 212 controls and 60 patients with sepsis. The optimal cut-off for the diagnosis of sepsis and the OR for CPD were established using a univariate logistic regression. A multivariate logistic regression model was then created. The OR and area under the curve were recorded. A risk stratification scale (neutrophils and monocytes (NEMO)) for diagnosing sepsis was established on the basis of the coefficients of the multivariate model.ResultsMO-X and neutrophils fluorescence intensity (NE-SFL) were found to be the most relevant of the CPD in predicting sepsis applying multivariate analysis to G1.NEMO score was composed using the above-mentioned CPD and subsequently stratified into three risk groups: mild (≤3), moderate (4≤NEMO≤5) and high (≥6). The OR for patients with a score of 4–5 was 10 and 249 for a score of ≥6. When applied to G2, the positive predictive value was 84.8 % and the negative predictive value was 96.0%.ConclusionsCPD are potentially useful for the early diagnosis of sepsis. Their values were used to compose in NEMO score can help in rapid and reliable decision making.

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“…The increased life expectancy of individuals (including those who are immune-compromised) and the surge seen with the utilization of invasive medical interventions are all important contributors to the high incidence of sepsis and its complications. International guidelines highlight the need for early identification of the condition and prompt implementation of the treatment, including antibiotics to reduce the serious consequences [8][9][10][11][12][13]. It has been observed that prompt administration of antibiotics and improve outcomes in patients with sepsis.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Outcome Among Severe Sepsis and Septic Shock Patients in a South Indian Tertiary Care Hospital

Babu

Menon

Devi

2017

Int J Pharm Pharm Sci

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Objective: The objective of this research was to determine the prevalence of severe sepsis and septic shock and evaluate its outcome.Methods: This was a prospective, observational study, in which adult patients with severe sepsis or septic shock were included. Relevant information was collected from medical records and the hospital information system. Results:A total of 250 patients [mean age 57.2 y (range: 18 to 98 y)] was studied. The majority of the patients suffered from severe sepsis (81.2%). Most of the episodes occurred in males (75.2%). Major comorbidities included diabetes mellitus (51.2%), hypertension (44.8%) and chronic liver disease (30.4%). One hundred and seventy-eight patients (147 patients with severe sepsis and 31 patients with septic shock) had a positive culture with urine being the main site of infection. One hundred and two patients (40.8%) had a monomicrobial infection while seventy-six (30.4%) patients had a polymicrobial infection. Within the monomicrobial infections, the gram negative organisms predominated (54%). The mean hospital stay for patients with severe sepsis was 11.5 d. Mortality was noted in 79 patients (40 patients with septic shock and 39 patients with severe sepsis). Conclusion:The main causative pathogens were gram negative bacteria. Admissions meeting septic shock criteria have a high mortality rate. Hence, it is imperative to identify patients who are at high risk and treat them promptly to reduce serious consequences.

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Diagnosing sepsis – The role of laboratory medicine

Cited by 141 publications

References 82 publications

Elevated Levels of Interleukin-27 in Early Life Compromise Protective Immunity in a Mouse Model of Gram-Negative Neonatal Sepsis

Elevated Levels of Interleukin-27 in Early Life Compromise Protective Immunity in a Mouse Model of Gram-Negative Neonatal Sepsis

Role of leucocytes cell population data in the early detection of sepsis

Epidemiology and Outcome Among Severe Sepsis and Septic Shock Patients in a South Indian Tertiary Care Hospital

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