1
|
Zhang R, Huang H, Lu S, Chen J, Pi D, Dang H, Liu C, Xu F, Fu YQ. Relationship between thrombocytopenia and prognosis in children with septic shock: a retrospective cohort study. Platelets 2024; 35:2363242. [PMID: 38860550 DOI: 10.1080/09537104.2024.2363242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024]
Abstract
Septic shock is a life-threatening disease worldwide often associated with thrombocytopenia. Platelets play a crucial role in bridging the gap between immunity, coagulation, and endothelial cell activation, potentially influencing the course of the disease. However, there are few studies specifically evaluating the impact of thrombocytopenia on the prognosis of pediatric patients. Therefore, the study investigates effects of early thrombocytopenia in the prognosis of children with septic shock. Pediatric patients with septic shock from 2015 to 2022 were included monocentrically. Thrombocytopenia was defined as a platelet count of <100 × 109/L during the first 24 hours of septic shock onset. The primary outcome was the 28-day mortality. Propensity score matching was used to pair patients with different platelet counts on admission but comparable disease severity. A total of 419 pediatric patients were included in the analysis. Patients with thrombocytopenia had higher 28-day mortality (55.5% vs. 38.7%, p = .005) compared to patients with no thrombocytopenia. Thrombocytopenia was associated with reduced 28-PICU free days (median value, 0 vs. 13 days, p = .003) and 28-ventilator-free (median value, 0 vs. 19 days, p = .001) days. Among thrombocytopenia patients, those with platelet count ≤50 × 109/L had a higher 28-day mortality rate (63.6% vs. 45%, p = .02). Multiple logistic regression showed that elevated lactate (adjusted odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.04-1.17; P <0.001) and white blood cell (WBC) count (OR = 0.97; 95% CI: 0.95-0.99; p = .003) were independent risk factors for the development of thrombocytopenia. Thrombocytopenia group had increased bleeding events, blood product transfusions, and development of organ failure. In Kaplan-Meier survival estimates, survival probabilities at 28 days were greater in patients without thrombocytopenia (p value from the log-rank test, p = .004). There were no significant differences in the type of pathogenic microorganisms and the site of infection between patients with and without thrombocytopenia. In conclusion, thrombocytopenia within 24 hours of shock onset is associated with an increased risk of 28-day mortality in pediatric patients with septic shock.
Collapse
Affiliation(s)
- Ruichen Zhang
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Haixin Huang
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Siwei Lu
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Chen
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dandan Pi
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongxing Dang
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chengjun Liu
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Xu
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yue-Qiang Fu
- Department of Critical Care Medicine, Children's Hospital Affiliated to Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
2
|
Worku M, Molla T, Kasew D, Assefa M, Geteneh A, Aynalem M, Gizachew M, Biset S. Antibiogram of Bacteria Isolated from Bloodstream Infection-Suspected Patients at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia: A Retrospective Study. Int J Microbiol 2024; 2024:7624416. [PMID: 39015246 PMCID: PMC11250713 DOI: 10.1155/2024/7624416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/03/2024] [Accepted: 06/19/2024] [Indexed: 07/18/2024] Open
Abstract
Background Bacterial bloodstream infections (BSIs) are the leading cause of sepsis-related morbidity and mortality worldwide. The emergence and spread of antimicrobial resistance (AMR) in bacteria is also a growing global concern. As a result, data on bacterial profile and their antibiogram are essential for strategies to contain drug resistance, improve the quality of patient care, and strengthen health systems. Methods Retrospective data from bacteriological results of blood samples of BSI-suspected patients from 2018 to 2021 were collected using a data collection sheet. Standard bacteriological techniques were followed during sample collection, culture preparation, bacterial identification, and antibiotic susceptibility testing (AST). We used Epi Info version 7 to enter and clean the data and then exported it to SPSS version 26 for analysis. Logistic regression models were used to measure the association between variables. A p value <0.05 with a 95% confidence interval was considered as statistically significant. Result Of the total 2,795 blood culture records, 455 (16.3%) were culture positive for bacteria, with Klebsiella pneumoniae (26%) and Staphylococcus aureus (24.6%) being the leading isolates. The isolates were highly resistant to common antibiotics, with more than 80% of them being resistant to ceftriaxone and penicillin. Moreover, about 43% of isolates were multidrug resistant (MDR), with Klebsiella pneumoniae (65.5%), Acinetobacter species (56.7%), and Citrobacter species (53.8%) being the most common MDR isolates. Age and diagnosis year were significantly associated with the presence of bacterial BSIs (p value <0.05). Conclusion Bacterial BSI and AMR were growing concerns in the study area. Bacteremia was more common in children under the age of five, and it decreased as the patient's age increased. The alarming rate of AMR, such as MDR blood isolates, calls for periodic and continuous monitoring of antibiotic usage in the study area.
Collapse
Affiliation(s)
- Minichil Worku
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Tigist Molla
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Desie Kasew
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
| | - Muluneh Assefa
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
| | - Alene Geteneh
- Department of Medical Laboratory ScienceCollege of Health SciencesWoldia University, Woldia, Ethiopia
| | - Melak Aynalem
- Department of Hematology and ImmunohematologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health ScienceUniversity of Gondar, Gondar, Ethiopia
| | - Mucheye Gizachew
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
| | - Sirak Biset
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
| |
Collapse
|
3
|
Brouwer L, Cunney R, Drew RJ. Predicting community acquired bloodstream infection in infants using full blood count parameters and C-reactive protein; a machine learning study. Eur J Pediatr 2024; 183:2983-2993. [PMID: 38634890 PMCID: PMC11192659 DOI: 10.1007/s00431-024-05441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/17/2024] [Indexed: 04/19/2024]
Abstract
Early recognition of bloodstream infection (BSI) in infants can be difficult, as symptoms may be non-specific, and culture can take up to 48 h. As a result, many infants receive unneeded antibiotic treatment while awaiting the culture results. In this study, we aimed to develop a model that can reliably identify infants who do not have positive blood cultures (and, by extension, BSI) based on the full blood count (FBC) and C-reactive protein (CRP) values. Several models (i.e. multivariable logistic regression, linear discriminant analysis, K nearest neighbors, support vector machine, random forest model and decision tree) were trained using FBC and CRP values of 2693 infants aged 7 to 60 days with suspected BSI between 2005 and 2022 in a tertiary paediatric hospital in Dublin, Ireland. All models tested showed similar sensitivities (range 47% - 62%) and specificities (range 85%-95%). A trained decision tree and random forest model were applied to the full dataset and to a dataset containing infants with suspected BSI in 2023 and showed good segregation of a low-risk and high-risk group. Negative predictive values for these two models were high for the full dataset (> 99%) and for the 2023 dataset (> 97%), while positive predictive values were low in both dataset (4%-20%). Conclusion: We identified several models that can predict positive blood cultures in infants with suspected BSI aged 7 to 60 days. Application of these models could prevent administration of antimicrobial treatment and burdensome diagnostics in infants who do not need them. What is Known: • Bloodstream infection (BSI) in infants cause non-specific symptoms and may be difficult to diagnose. • Results of blood cultures can take up to 48 hours. What is New: • Machine learning models can contribute to clinical decision making on BSI in infants while blood culture results are not yet known.
Collapse
Affiliation(s)
- Lieke Brouwer
- Public Health Laboratory, HSE, Cherry Orchard Hospital, Dublin, Ireland.
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden.
| | - Robert Cunney
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard J Drew
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland
| |
Collapse
|
4
|
Lungu N, Popescu DE, Gorun FI, Nan G, Popa ZL, Manea A, Brandibur TE, Jura AMC, Costescu S, Belovan B, Boia M. D-dimer as a Useful Biomarker in Early Diagnosis of Neonatal Sepsis: A Single-Center Study From Romania. Cureus 2024; 16:e65213. [PMID: 39045021 PMCID: PMC11265774 DOI: 10.7759/cureus.65213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND This study evaluates the role of D-dimer in identifying neonatal sepsis and their potential value in clinical decision-making due to challenges in early detection. METHODOLOGY A case-control study was conducted on 102 neonates at the Children's Clinical Hospital "Louis Turcanu" in Timisoara, Romania, from October 2018 to July 2023. The participants were divided into two groups: those with neonatal sepsis and those without sepsis. RESULTS The study found that neonates with sepsis were more likely to be delivered by cesarean section and had higher rates of premature ruptured membranes compared to those without sepsis. The D-dimer biomarker's predictive value for sepsis was assessed using a receiver operating characteristic (ROC) curve, with an area under the curve (AUC) exceeding 0.982 and an optimum cutoff value of 342 ng/mL. An increase in neonatal D-dimer significantly increases the likelihood of sepsis by 2.7% per unit increase. A value above 250 ng/mL indicates a 127-fold increased likelihood of sepsis. The D-dimer's ability to predict mortality in newborns with sepsis is unsatisfactory, with an AUC of 0.528. CONCLUSIONS D-dimer, a potential biomarker of neonatal sepsis, warrants further clinical investigation to enhance diagnostic sensitivity and specificity, demonstrating its potential in conjunction with other sepsis markers.
Collapse
Affiliation(s)
- Nicoleta Lungu
- Department of Obstetrics-Gynecology and Neonatology, Victor Babeş University of Medicine and Pharmacy, Timisoara, ROU
| | - Daniela-Eugenia Popescu
- Department of Obstetrics-Gynecology and Neonatology, Victor Babeş University of Medicine and Pharmacy, Timisoara, ROU
| | - Florin I Gorun
- Department of Obstetrics and Gynecology, Timisoara Clinical Municipal Emergency Hospital, Timisoara, ROU
| | - Georgiana Nan
- Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital, Timisoara, ROU
| | - Zoran L Popa
- Department of Obstetrics-Gynecology and Neonatology, Victor Babeş University of Medicine and Pharmacy, Timisoara, ROU
| | - Aniko Manea
- Department of Obstetrics-Gynecology and Neonatology, Victor Babeş University of Medicine and Pharmacy, Timisoara, ROU
| | - Timea Elisabeta Brandibur
- Department of Obstetrics-Gynecology and Neonatology, Victor Babeş University of Medicine and Pharmacy, Timisoara, ROU
| | | | - Sergiu Costescu
- Department of Obstetrics and Gynecology, Oravita City Hospital, Oravita, ROU
| | - Biliana Belovan
- Doctoral School, Victor Babeş University of Medicine and Pharmacy, Timisoara, ROU
| | - Marioara Boia
- Department of Obstetrics-Gynecology and Neonatology, Victor Babeş University of Medicine and Pharmacy, Timisoara, ROU
| |
Collapse
|
5
|
Wu Y, Wang L, Li Y, Cao Y, Wang M, Deng Z, Kang H. Immunotherapy in the context of sepsis-induced immunological dysregulation. Front Immunol 2024; 15:1391395. [PMID: 38835773 PMCID: PMC11148279 DOI: 10.3389/fimmu.2024.1391395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Sepsis is a clinical syndrome caused by uncontrollable immune dysregulation triggered by pathogen infection, characterized by high incidence, mortality rates, and disease burden. Current treatments primarily focus on symptomatic relief, lacking specific therapeutic interventions. The core mechanism of sepsis is believed to be an imbalance in the host's immune response, characterized by early excessive inflammation followed by late immune suppression, triggered by pathogen invasion. This suggests that we can develop immunotherapeutic treatment strategies by targeting and modulating the components and immunological functions of the host's innate and adaptive immune systems. Therefore, this paper reviews the mechanisms of immune dysregulation in sepsis and, based on this foundation, discusses the current state of immunotherapy applications in sepsis animal models and clinical trials.
Collapse
Affiliation(s)
- Yiqi Wu
- Department of Critical Care Medicine, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School of The People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Lu Wang
- Department of Critical Care Medicine, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School of The People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yun Li
- Department of Critical Care Medicine, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School of The People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuan Cao
- Department of Emergency Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Min Wang
- Department of Critical Care Medicine, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School of The People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zihui Deng
- Department of Basic Medicine, Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Hongjun Kang
- Department of Critical Care Medicine, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| |
Collapse
|
6
|
Zhuxiao R, Shuo Y, Jiangxue H, Jingjun P, Qi Z, Zhu W, Fang X, Jie Y. Antimicrobial peptide LL37 and regulatory T cell associated with late-onset sepsis in very preterm infants. iScience 2024; 27:109780. [PMID: 38736551 PMCID: PMC11088333 DOI: 10.1016/j.isci.2024.109780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/05/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Stem cell therapy may prevent late-onset sepsis (LOS) via antimicrobial peptide LL37 secretion and regulatory T cell (Treg) regulation. The early prediction of LOS is still a challenge. This study evaluated whether immunological state of LL37 or Tregs precedes LOS. We firstly analyzed the LL37 level, Treg proportion, and LOS incidence in very preterm infants treated with autologous cord blood mononuclear cells (ACBMNCs) in our previous trial. Then, we constructed a prediction model and built validation cohort. We found ACBMNC intervention reduced the incidence of LOS from 27.3% to 6.9% (p = 0.021). LL37 and Treg abundances were higher in the ACBMNCs group. The nomogram demonstrated that early-life Treg and LL37 characteristics were closely associated with LOS (area under the curve, AUC 0.936), with implications for early prediction and timely clinical management. This composite model was also helpful to evaluate the beneficial effect of ACBMNCs intervention on LOS, thus promoting translational research.
Collapse
Affiliation(s)
- Ren Zhuxiao
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangzhou Medical University, Guangdong Neonatal ICU Medical Quality Control Center, National Key Clinical Specialty Construction Unit Guangzhou Medical University, Guangzhou 510000, Guangdong, China
| | - Yang Shuo
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Han Jiangxue
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangzhou Medical University, Guangdong Neonatal ICU Medical Quality Control Center, National Key Clinical Specialty Construction Unit Guangzhou Medical University, Guangzhou 510000, Guangdong, China
| | - Pei Jingjun
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhang Qi
- Department of Clinical Genetic Center, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Wang Zhu
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangzhou Medical University, Guangdong Neonatal ICU Medical Quality Control Center, National Key Clinical Specialty Construction Unit Guangzhou Medical University, Guangzhou 510000, Guangdong, China
| | - Xu Fang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangzhou Medical University, Guangdong Neonatal ICU Medical Quality Control Center, National Key Clinical Specialty Construction Unit Guangzhou Medical University, Guangzhou 510000, Guangdong, China
| | - Yang Jie
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
7
|
Huang SSY, Toufiq M, Eghtesady P, Van Panhuys N, Garand M. The molecular landscape of sepsis severity in infants: enhanced coagulation, innate immunity, and T cell repression. Front Immunol 2024; 15:1281111. [PMID: 38817614 PMCID: PMC11137207 DOI: 10.3389/fimmu.2024.1281111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Sepsis remains a major cause of mortality and morbidity in infants. In recent years, several gene marker strategies for the early identification of sepsis have been proposed but only a few have been independently validated for adult cohorts and applicability to infant sepsis remains unclear. Biomarkers to assess disease severity and risks of shock also represent an important unmet need. Methods To elucidate characteristics driving sepsis in infants, we assembled a multi-transcriptomic dataset from public microarray datasets originating from five independent studies pertaining to bacterial sepsis in infant < 6-months of age (total n=335). We utilized a COmbat co-normalization strategy to enable comparative evaluation across multiple studies while preserving the relationship between cases and controls. Results We found good concordance with only two out of seven of the published adult sepsis gene signatures (accuracy > 80%), highlighting the narrow utility of adult-derived signatures for infant diagnosis. Pseudotime analysis of individual subjects' gene expression profiles showed a continuum of molecular changes forming tight clusters concurrent with disease progression between healthy controls and septic shock cases. In depth gene expression analyses between bacteremia, septic shock, and healthy controls characterized lymphocyte activity, hemostatic processes, and heightened innate immunity during the molecular transition toward a state of shock. Discussion Our analysis revealed the presence of multiple significant transcriptomic perturbations that occur during the progression to septic shock in infants that are characterized by late-stage induction of clotting factors, in parallel with a heightened innate immune response and a suppression of adaptive cell functionality.
Collapse
Affiliation(s)
- Susie Shih Yin Huang
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
- Department of Immunology, Sidra Medicine, Doha, Qatar
| | | | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | | | - Mathieu Garand
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
- Department of Immunology, Sidra Medicine, Doha, Qatar
| |
Collapse
|
8
|
Duignan SM, Lakshminrusimha S, Armstrong K, de Boode WP, El-Khuffash A, Franklin O, Molloy EJ. Neonatal sepsis and cardiovascular dysfunction I: mechanisms and pathophysiology. Pediatr Res 2024; 95:1207-1216. [PMID: 38044334 DOI: 10.1038/s41390-023-02926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023]
Abstract
The highest incidence of sepsis across all age groups occurs in neonates leading to substantial mortality and morbidity. Cardiovascular dysfunction frequently complicates neonatal sepsis including biventricular systolic and/or diastolic dysfunction, vasoregulatory failure, and pulmonary arterial hypertension. The haemodynamic response in neonatal sepsis can be hyperdynamic or hypodynamic and the underlying pathophysiological mechanisms are heterogeneous. The diagnosis and definition of both neonatal sepsis and cardiovascular dysfunction complicating neonatal sepsis are challenging and not consensus-based. Future developments in neonatal sepsis management will be facilitated by common definitions and datasets especially in neonatal cardiovascular optimisation. IMPACT: Cardiovascular dysfunction is common in neonatal sepsis but there is no consensus-based definition, making calculating the incidence and designing clinical trials challenging. Neonatal cardiovascular dysfunction is related to the inflammatory response, which can directly target myocyte function and systemic haemodynamics.
Collapse
Affiliation(s)
- Sophie M Duignan
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | | | - Kathryn Armstrong
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada
| | - Willem P de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Afif El-Khuffash
- School of Medicine, Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Orla Franklin
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- Discipline of Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland
| | - Eleanor J Molloy
- Discipline of Paediatrics, Trinity College, The University of Dublin, Trinity Research in Childhood (TRiCC) & Trinity Translational Medicine Institute (TTMI), Dublin, Ireland.
- Department of Neonatology, Children's Health Ireland at Crumlin, Dublin, Ireland.
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Ireland.
- Paediatric Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland.
| |
Collapse
|
9
|
Sacchetti S, Vidali M, Esposito T, Zorzi S, Burgener A, Ciccarello L, Cammarota G, Zanotti V, Giacomini L, Bellan M, Pirisi M, Lopez RS, Dianzani U, Vaschetto R, Rolla R. The Role of New Morphological Parameters Provided by the BC 6800 Plus Analyzer in the Early Diagnosis of Sepsis. Diagnostics (Basel) 2024; 14:340. [PMID: 38337856 PMCID: PMC10855753 DOI: 10.3390/diagnostics14030340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Late diagnosis of sepsis is associated with adverse consequences and high mortality rate. The aim of this study was to evaluate the diagnostic value of hematologic research parameters, that reflect the cell morphology of blood cells, available on the BC 6800 plus automated analyzer (Mindray) for the early detection of sepsis. MATERIALS AND METHODS A complete blood count (CBC) was performed by Mindray BC 6800 Plus Analyzer in 327 patients (223 with a confirmed diagnosis of sepsis following sepsis-3 criteria, 104 without sepsis), admitted at the Intensive Care Unit of the Novara's Hospital (Italy) and in 56 patients with localized infection. RESULTS In univariate logistic regression, age, Hb, RDW, MO#, NMR, NeuX, NeuY, NeuZ, LymX, MonX, MonY, MonZ were associated with sepsis (p < 0.005). In multivariate analysis, only RDW, NeuX, NeuY, NeuZ, MonX and MonZ were found to be independent predictors of sepsis (p < 0.005). Morphological research parameters are confirmed to be predictors of sepsis even when analyzing the group with localized infection. CONCLUSIONS In addition to already established biomarkers and basic CBC parameters, new morphological cell parameters can be a valuable aid in the early diagnosis of sepsis at no additional cost.
Collapse
Affiliation(s)
- Sara Sacchetti
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Matteo Vidali
- Clinical Pathology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Teresa Esposito
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Stefano Zorzi
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Alessia Burgener
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Lorenzo Ciccarello
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Gianmaria Cammarota
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Valentina Zanotti
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Luca Giacomini
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Mattia Bellan
- Department of Translational Medicine, Division of Internal Medicine, Università del Piemonte Orientale, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (M.B.); (M.P.)
| | - Mario Pirisi
- Department of Translational Medicine, Division of Internal Medicine, Università del Piemonte Orientale, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (M.B.); (M.P.)
| | - Ramon Simon Lopez
- Medical Xpert Systems SA, Brunnenmattstrasse 6, 6317 Oberwil bei Zug, Switzerland;
| | - Umberto Dianzani
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Rosanna Vaschetto
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Roberta Rolla
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| |
Collapse
|
10
|
Chen X, He H, Wei H, Chen F, Hu Y. Risk factors for death caused by early onset sepsis in neonates: a retrospective cohort study. BMC Infect Dis 2023; 23:844. [PMID: 38036977 PMCID: PMC10687896 DOI: 10.1186/s12879-023-08851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/27/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE To evaluate the association between traditional laboratory findings and death, and to find risk factors for death in infants with early onset sepsis (EOS). STUDY DESIGN This was a single-center, case-control, retrospective trial conducted between January 2020 and August 2021. Infants with EOS were enrolled and divided into two groups based on outcome before hospital discharge: non-survivors (Mortality group) and survivors (Survival group). RESULTS Out of 556 eligible neonates, there were 38 (6.8%) deaths. After univariate analysis and ROC curve analysis, there were a total of 12 values with significant differences (p < 0.05) between two groups, which included birth weight (BW), weight on admission, gestational age, age on admission, mode of delivery, septic shock, heart failure, respiratory failure, pulmonary hypertension, hypothermia, serum lactic acid, and aspartate aminotransferase (AST). Moreover, after multivariate analysis performed for those 12 values, the binary logistic regression analysis showed that taking death as a reference, the BW (OR = 1.00, 95% CI[1.001, 1.002], p < 0.001), PPHN (OR = 2.60, 95% CI[1.04, 6.52], p > 0.001), septic shock (OR = 6.15, 95% CI [2.52, 15.00], p < 0.001), heart failure (OR = 6.22, 95% CI[0.90, 43.05], p > 0.001), serum lactic acid (OR = 0.82, 95%CI[0.75, 0.90], p < 0.001), and AST (OR = 1.00, 95% CI[0.99, 1.00], p > 0.001) could be regarded as risk factors for death with 94.0% correct predictions. CONCLUSIONS The factors affecting the prognosis of EOS in neonates were BW, PPHN, septic shock, heart failure, serum lactic acid, and AST. Timely correction of these modifiable risk factors for death may decrease the mortality of EOS in neonates.
Collapse
Affiliation(s)
- Xinhong Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Huayun He
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Hong Wei
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China
| | - Feng Chen
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ya Hu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Chongqing Higher Institution Engineering Research Center of Children's Medical Big Data Intelligent Application, Chongqing, China.
| |
Collapse
|
11
|
Zhu X, Pan Y, Xu X, Xu J. Kaempferitrin alleviates LPS-induced septic acute lung injury in mice through downregulating NF-κB pathway. Allergol Immunopathol (Madr) 2023; 51:1-7. [PMID: 37937489 DOI: 10.15586/aei.v51i6.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Acute lung injury (ALI) causes severe and uncontrolled pulmonary inflammation and has high morbidity in dying patients. OBJECTIVE This study aimed to evaluate the potential function of Kaempferitrin (Kae) and uncover its mechanisms in ALI. MATERIAL AND METHODS We evaluated the role of Kae in ALI through the lipopolysaccharide (LPS)-induced histopathological changes, lung wet/dry (W/D) ratio, total bronchoalveolar lavage fluid (BALF) cells count, pulmonary inflammation, and the levels of interleukin (IL)-6, tumor necrosis factor-α (TNF-α), and IL-1β. The effect of Kae on NF-κB signaling pathway was discovered through the protein expression levels of transcription factors p65, p-p65, IκBα, and p-IκBα by Western blot analysis. RESULTS The results showed that Kae could improve lung injury by reducing apoptosis, histopathological changes, and lung W/D ratio; more importantly, Kae enhanced the survival of ALI mice. Moreover, Kae relieved inflammation, as it reduced total BALF cells count, and deceased the levels of TNF-α, IL-6, and IL-1β in serum. In addition, Western blot analysis data suggested that Kae could decrease the protein expression levels of transcription factors p65, p-p65, IκB-α, and p-IκB-α, which were promoted by LPS. CONCLUSION The results of this study suggested that Kae could relieve LPS-induced ALI in mice and reduce inflammation and apoptosis through NF-κB pathway.
Collapse
Affiliation(s)
- Xiaoli Zhu
- Critical Care Medicine, Zhejiang Youth Hospital, Hangzhou, Zhejiang Province, China;
| | - Yongyue Pan
- Critical Care Medicine, Zhejiang Youth Hospital, Hangzhou, Zhejiang Province, China
| | - Xin Xu
- Critical Care Medicine, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang Province, China
| | - Jing Xu
- Critical Care Medicine, Zhejiang Youth Hospital, Hangzhou, Zhejiang Province, China
| |
Collapse
|
12
|
Zhang WY, Chen ZH, An XX, Li H, Zhang HL, Wu SJ, Guo YQ, Zhang K, Zeng CL, Fang XM. Analysis and validation of diagnostic biomarkers and immune cell infiltration characteristics in pediatric sepsis by integrating bioinformatics and machine learning. World J Pediatr 2023; 19:1094-1103. [PMID: 37115484 PMCID: PMC10533616 DOI: 10.1007/s12519-023-00717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Pediatric sepsis is a complicated condition characterized by life-threatening organ failure resulting from a dysregulated host response to infection in children. It is associated with high rates of morbidity and mortality, and rapid detection and administration of antimicrobials have been emphasized. The objective of this study was to evaluate the diagnostic biomarkers of pediatric sepsis and the function of immune cell infiltration in the development of this illness. METHODS Three gene expression datasets were available from the Gene Expression Omnibus collection. First, the differentially expressed genes (DEGs) were found with the use of the R program, and then gene set enrichment analysis was carried out. Subsequently, the DEGs were combined with the major module genes chosen using the weighted gene co-expression network. The hub genes were identified by the use of three machine-learning algorithms: random forest, support vector machine-recursive feature elimination, and least absolute shrinkage and selection operator. The receiver operating characteristic curve and nomogram model were used to verify the discrimination and efficacy of the hub genes. In addition, the inflammatory and immune status of pediatric sepsis was assessed using cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT). The relationship between the diagnostic markers and infiltrating immune cells was further studied. RESULTS Overall, after overlapping key module genes and DEGs, we detected 402 overlapping genes. As pediatric sepsis diagnostic indicators, CYSTM1 (AUC = 0.988), MMP8 (AUC = 0.973), and CD177 (AUC = 0.986) were investigated and demonstrated statistically significant differences (P < 0.05) and diagnostic efficacy in the validation set. As indicated by the immune cell infiltration analysis, multiple immune cells may be involved in the development of pediatric sepsis. Additionally, all diagnostic characteristics may correlate with immune cells to varying degrees. CONCLUSIONS The candidate hub genes (CD177, CYSTM1, and MMP8) were identified, and the nomogram was constructed for pediatric sepsis diagnosis. Our study could provide potential peripheral blood diagnostic candidate genes for pediatric sepsis patients.
Collapse
Affiliation(s)
- Wen-Yuan Zhang
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China
| | - Zhong-Hua Chen
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China
- Department of Anesthesiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | | | - Hui Li
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China
| | - Hua-Lin Zhang
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China
| | - Shui-Jing Wu
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China
| | - Yu-Qian Guo
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China
| | - Kai Zhang
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China
| | - Cong-Li Zeng
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Xiang-Ming Fang
- Department of Anesthesiology and Intensive Care, School of Medicine, The First Affiliated Hospital, Zhejiang University, QingChun Road 79, Hangzhou, 310003, China.
| |
Collapse
|
13
|
Liu X, Mu Y. Lymphocyte to C-Reactive Protein Ratio as an Early Biomarker to Distinguish Sepsis from Pneumonia in Neonates. J Inflamm Res 2023; 16:3509-3517. [PMID: 37608883 PMCID: PMC10441656 DOI: 10.2147/jir.s424897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023] Open
Abstract
Background Neonatal sepsis is an acute and severe disease that seriously threatens the life and health of newborns. Neonates with pneumonia may also have unrecognized neonatal sepsis. Early diagnosis of neonatal sepsis is beneficial for early treatment. This study aimed to evaluate the clinical significance of the lymphocyte-to-C-reactive protein ratio (LCR) as an early biomarker to distinguish sepsis from pneumonia. Methods This retrospective study enrolled 1635 neonates with pneumonia from February 2016 to March 2022. Among them, 182 cases were diagnosed with sepsis based on the positive blood culture results. Clinical and laboratory data were extracted from the electronic medical records. LCR was calculated as the ratio of the total lymphocyte count (×109 cells/L) to the C-reactive protein level (mg/L). Binary logistic regression analysis was conducted to evaluate the clinical significance of LCR as an early biomarker in distinguishing sepsis from pneumonia. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic value of LPCR in sepsis cases. All statistical analyses were conducted using Statistical Product and Service Solutions, version 24.0. Results The neonates with pneumonia combined with sepsis had a lower LCR than that of the neonates with pneumonia. Further analysis showed that the prevalence of neonatal pneumonia combined with sepsis was significantly higher in the low-LCR group than in the high-LCR group (20.7% vs 5.5%, P < 001). Binary logistic regression revealed that LCR was an independent risk factor for identifying pneumonia combined with sepsis. The ROC curve analysis revealed that LCR had better power than the lymphocyte count and CRP level individually in diagnosing neonatal pneumonia combined with sepsis (0.72 vs 0.65 vs 0.66, P < 0.001), with 62% sensitivity and 72% specificity. Conclusion LCR can be a potential early biomarker in distinguishing neonates with sepsis from those with pneumonia.
Collapse
Affiliation(s)
- Xinrui Liu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Yuan Mu
- Institute of Thermology, Henan Institute of Metrology and Testing Sciences, Zhengzhou, People’s Republic of China
| |
Collapse
|
14
|
Li S, Wang Q, Tan X, Wang L, Gong J, Zhang J, Wang W, Liu J. Effect of neonatal and adult sepsis on inflammation-related diseases in multiple physiological systems: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1215751. [PMID: 37547313 PMCID: PMC10400313 DOI: 10.3389/fendo.2023.1215751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background Long-term impact of sepsis on whole body systems is not well investigated. The aim of the study was to explore the potential association of neonatal/adult sepsis with several inflammation-related diseases in multiple physiological systems. Methods Instrumental variables for neonatal and adult sepsis were collected from the public genome-wide association studies, which must satisfy the correlation, exclusivity and independence assumptions. Mendelian randomization methods (including random-effect inverse-variance weighted, MR-PRESSO, weighted median and MR-Egger) were used to determine the genetic association of neonatal/adult sepsis with asthma, allergy, rheumatoid arthritis, body mass index/obesity, type 1/type 2 diabetes and intelligence/dementia. Sensitivity analyses were conducted to assess heterogeneity and horizontal pleiotropy. The study was performed by TwoSampleMR in R software. Results The inverse-variance weighted method reported that neonatal sepsis was related to the decreased level of body mass index (OR = 0.988, 95%CI = 0.980 ~ 0.997, P = 0.007), and adult sepsis was related to the decreased risk of obesity (OR = 0.785, 95%CI = 0.655 ~ 0.940, P = 0.009). These results were supported by the other Mendelian randomization methods. In addition, the study did not find any association of neonatal/adult sepsis with the other inflammation-related diseases. No heterogeneity and horizontal pleiotropy were found using sensitivity analyses. Conclusion Sepsis had the potential to reduce the risk of obesity or body mass index level at a genetic level, both in neonates and in adults.
Collapse
Affiliation(s)
- Suping Li
- Department of Neonatal Intensive Care Unit, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Qian Wang
- Department of Neonatal Intensive Care Unit, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Xin Tan
- Department of Pediatrics, The First Hospital of Changsha, Changsha, Hunan, China
| | - Linghua Wang
- Department of Neonatal Intensive Care Unit, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jin Gong
- Department of Neonatal Intensive Care Unit, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Juan Zhang
- Department of Neonatal Intensive Care Unit, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Weilin Wang
- Department of Neonatal Intensive Care Unit, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jiangling Liu
- Department of Neonatal Intensive Care Unit, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| |
Collapse
|
15
|
Honoré A, Forsberg D, Adolphson K, Chatterjee S, Jost K, Herlenius E. Vital sign-based detection of sepsis in neonates using machine learning. Acta Paediatr 2023; 112:686-696. [PMID: 36607251 DOI: 10.1111/apa.16660] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
AIM Sepsis is a leading cause of morbidity and mortality in neonates. Early diagnosis is key but difficult due to non-specific signs. We investigate the predictive value of machine learning-assisted analysis of non-invasive, high frequency monitoring data and demographic factors to detect neonatal sepsis. METHODS Single centre study, including a representative cohort of 325 infants (2866 hospitalisation days). Personalised event timelines including interventions and clinical findings were generated. Time-domain features from heart rate, respiratory rate and oxygen saturation values were calculated and demographic factors included. Sepsis prediction was performed using Naïve Bayes algorithm in a maximum a posteriori framework up to 24 h before clinical sepsis suspicion. RESULTS Twenty sepsis cases were identified. Combining multiple vital signs improved algorithm performance compared to heart rate characteristics alone. This enabled a prediction of sepsis with an area under the receiver operating characteristics curve of 0.82, up to 24 h before clinical sepsis suspicion. Moreover, 10 h prior to clinical suspicion, the risk of sepsis increased 150-fold. CONCLUSION The present algorithm using non-invasive patient data provides useful predictive value for neonatal sepsis detection. Machine learning-assisted algorithms are promising novel methods that could help individualise patient care and reduce morbidity and mortality.
Collapse
Affiliation(s)
- Antoine Honoré
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Division of Information Science and Engineering, Royal Institute of Technology - KTH, Stockholm, Sweden
| | - David Forsberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Adolphson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Saikat Chatterjee
- Division of Information Science and Engineering, Royal Institute of Technology - KTH, Stockholm, Sweden
| | - Kerstin Jost
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Herlenius
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Imbalanced Inflammatory Responses in Preterm and Term Cord Blood Monocytes and Expansion of the CD14 +CD16 + Subset upon Toll-like Receptor Stimulation. Int J Mol Sci 2023; 24:ijms24054919. [PMID: 36902350 PMCID: PMC10002861 DOI: 10.3390/ijms24054919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Developmentally regulated features of innate immunity are thought to place preterm and term infants at risk of infection and inflammation-related morbidity. Underlying mechanisms are incompletely understood. Differences in monocyte function including toll-like receptor (TLR) expression and signaling have been discussed. Some studies point to generally impaired TLR signaling, others to differences in individual pathways. In the present study, we assessed mRNA and protein expression of pro- and anti-inflammatory cytokines in preterm and term cord blood (CB) monocytes compared with adult controls stimulated ex vivo with Pam3CSK4, zymosan, polyinosinic:polycytidylic acid, lipopolysaccharide, flagellin, and CpG oligonucleotide, which activate the TLR1/2, TLR2/6, TLR3, TLR4, TLR5, and TLR9 pathways, respectively. In parallel, frequencies of monocyte subsets, stimulus-driven TLR expression, and phosphorylation of TLR-associated signaling molecules were analyzed. Independent of stimulus, pro-inflammatory responses of term CB monocytes equaled adult controls. The same held true for preterm CB monocytes-except for lower IL-1β levels. In contrast, CB monocytes released lower amounts of anti-inflammatory IL-10 and IL-1ra, resulting in higher ratios of pro-inflammatory to anti-inflammatory cytokines. Phosphorylation of p65, p38, and ERK1/2 correlated with adult controls. However, stimulated CB samples stood out with higher frequencies of intermediate monocytes (CD14+CD16+). Both pro-inflammatory net effect and expansion of the intermediate subset were most pronounced upon stimulation with Pam3CSK4 (TLR1/2), zymosan (TR2/6), and lipopolysaccharide (TLR4). Our data demonstrate robust pro-inflammatory and yet attenuated anti-inflammatory responses in preterm and term CB monocytes, along with imbalanced cytokine ratios. Intermediate monocytes, a subset ascribed pro-inflammatory features, might participate in this inflammatory state.
Collapse
|
17
|
Ma J, Chen X, Wang X, Liang J, Guo L, Su Y, Hao L, Ren C. The accuracy of soluble urokinase-type plasminogen activator receptor for the diagnosis of neonatal sepsis: a meta-analysis. Front Med (Lausanne) 2023; 10:1169114. [PMID: 37181361 PMCID: PMC10174239 DOI: 10.3389/fmed.2023.1169114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023] Open
Abstract
Background Neonatal sepsis is one of the major causes of morbidity and mortality in newborns. However, atypical clinical manifestations and symptoms make the early diagnosis of neonatal sepsis a challenge. Relatively high-serum soluble urokinase-type plasminogen activator receptor (suPAR) has been implicated as a diagnostic biomarker for adult sepsis. Therefore, the meta-analysis is intended to explore the diagnostic value of suPAR for neonatal sepsis. Methods The PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Biological Medicine Disk, and Wanfang databases were retrieved from inception to 31 December 2022 to collect diagnostic accuracy studies about suPAR for neonatal sepsis. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies using the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) tool. Then, a meta-analysis was performed using Stata 15.0 software. Results A total of six articles involving eight studies were included. The results of the meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.89 [95%CI (0.83-0.93)], 0.94 [95%CI (0.77-0.98)], 14 [95%CI (3.5-55.2)], 0.12 [95%CI (0.08-0.18)], and 117 [95%CI (24-567)], respectively. The area under the curve (AUC) of summary receiver operator characteristic (SROC) curves was 0.92 [95%CI (0.90-0.94)]. Sensitivity analysis confirmed the stability of the results, and publication bias was not observed. Fagan's nomogram results demonstrated the clinical availability of the findings. Conclusion Current evidence suggests that suPAR has potential diagnostic value for neonatal sepsis. Owing to the limited quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Collapse
|
18
|
Li X, Li T, Dong G, Wei Y, Xu Z, Yang J. Clinical Value of Serum Interleukin-18 in Neonatal Sepsis Diagnosis and Mortality Prediction. J Inflamm Res 2022; 15:6923-6930. [PMID: 36605131 PMCID: PMC9809175 DOI: 10.2147/jir.s393506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose Previous studies have demonstrated that interleukin-18 (IL-18) levels were elevated in adult patients with sepsis. However, its role in neonatal sepsis remains unknown. The current research was conducted to assess the clinical value of serum IL-18 level as a candidate biomarker in neonatal sepsis diagnosis and prediction of mortality. Patients and Methods From July 2022 to September 2022, we prospectively enrolled 91 septic neonates and 31 non-sepsis neonates in the intensive care unit of neonates at Henan Children's Hospital in Zhengzhou, China. Neonatal peripheral blood serum was collected at admission and levels of serum IL-18 were assessed. Employing multivariate logistic regression analysis, the evaluation of the potential of IL-18 as an independent biomarker for sepsis was executed. Furthermore, employing the receiver operating characteristic (ROC) curve analysis, the diagnostic value of IL-18 in sepsis and the ability of IL-18 in predicting the mortality of neonatal sepsis was measured. The statistical package SPSS 24.0 was employed to conduct all statistical analyses. Results Serum IL-18 levels in neonates in the sepsis group were elevated compared to the control group, reaching the highest levels in the non-survival sepsis group (P < 0.001). Correlation analysis exhibited a positive relationship between IL-18 levels and age, body temperature, respiratory rate, and C-reactive protein levels. IL-18 was identified as an independent biomarker in identifying sepsis (OR = 4.747, 95% CI 1.493-15.092, P = 0.008) by multiple logistic regression. ROC curve analysis exhibited that IL-18 was good in identifying neonatal sepsis (area under curve (AUC) = 0.77, 95% CI = 0.68-0.85, P < 0.001) and predicting neonatal mortality (AUC = 0.80, 95% CI = 0.63-0.96, P = 0.003). Conclusion IL-18 was a potential biomarker for identifying neonatal sepsis and neonatal mortality prediction.
Collapse
Affiliation(s)
- Xiaojuan Li
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Tiewei Li
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China,Correspondence: Tiewei Li, Email
| | - Geng Dong
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Yulei Wei
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Zhe Xu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| |
Collapse
|