Usefulness of sepsis screening tools and education in recognising the burden of sepsis on hospital wards

Serum Resistin as a Potential Mortality Predictor in Neonatal Sepsis

Aim The aim of this study was to investigate the utility of serum resistin levels as a prognostic indicator for mortality in neonates diagnosed with sepsis. Methodology This one-year prospective study at Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, India, included 151 neonates categorized into two groups based on blood culture results: group 1 (n=86) included those with culture-negative, probable sepsis and group 2 (n=65) included those with culture-positive, proven sepsis. Blood samples obtained pre-treatment underwent comprehensive analysis, including complete blood count, C-reactive protein assessment, micro-erythrocyte sedimentation rate, and resistin level measurement via enzyme-linked immunosorbent assay. The comparison between groups was conducted using either the Student t-test or the Mann-Whitney U test, while correlations were assessed using the Spearman correlation. These analyses were employed to identify the optimal resistin cut-off for distinguishing patients with sepsis. A p-value of <0.05 was considered statistically significant. Results This study with 151 neonates diagnosed with sepsis found a significant association (p < 0.05) between elevated serum resistin levels and increased mortality risk. Multivariate analysis confirmed an independent predictive role of resistin. Elevated resistin levels correlate with higher chances of requiring mechanical ventilation and prolonged hospital stays. These findings highlight serum resistin's potential as a prognostic tool for the early identification of high-risk neonatal sepsis patients. Conclusion This study highlights the link between elevated serum resistin levels and increased mortality risk in neonatal sepsis, supported by strong multivariate analysis, indicating an independent predictive role. Additionally, resistin correlates with higher chances of mechanical ventilation and prolonged hospitalization, suggesting its potential as a prognostic marker for early identification of high-risk neonatal sepsis cases.

The SIRT1-HMGB1 axis: Therapeutic potential to ameliorate inflammatory responses and tumor occurrence

Inflammation is a common complication of many chronic diseases. It includes inflammation of the parenchyma and vascular systems. Sirtuin 1 (SIRT1) is a nicotinamide adenine dinucleotide (NAD)-dependent histone deacetylase, which can directly participate in the suppression of inflammation. It can also regulate the activity of other proteins. Among them, high mobility group box 1 (HMGB1) signaling can be inhibited by deacetylating four lysine residues (55, 88, 90, and 177) in quiescent endothelial cells. HMGB1 is a ubiquitous nuclear protein, once translocated outside the cell, which can interact with various target cell receptors including the receptor for advanced glycation end-products (RAGE), toll-like receptor (TLR) 2, and TLR4 and stimulates the release of pro-inflammatory cyto-/chemokines. And SIRT1 has been reported to inhibit the activity of HMGB1. Both are related to the occurrence and development of inflammation and associated diseases but show an antagonistic relationship in controlling inflammation. Therefore, in this review, we introduce how this signaling axis regulates the emergence of inflammation-related responses and tumor occurrence, providing a new experimental perspective for future inflammation research. In addition, it explores diverse upstream regulators and some natural/synthetic activators of SIRT1 as a possible treatment for inflammatory responses and tumor occurrence which may encourage the development of new anti-inflammatory drugs. Meanwhile, this review also introduces the potential molecular mechanism of the SIRT1-HMGB1 pathway to improve inflammation, suggesting that SIRT1 and HMGB1 proteins may be potential targets for treating inflammation.

Relationship Between Resistin Levels and Sepsis Among Children Under 12 Years of Age: A Case Control Study

Objective: The aim of this study was to investigate the level of resistin in children with and without sepsis hospitalized in the pediatric intensive care unit (PICU) and compare them to levels in healthy subjects in order to determine the trend of resistin levels in children in PICUs and also to identify the cut-off values for positive sepsis. Methods: This was a case-control study conducted in 2014 at a children's hospital in Tabriz, Iran. Three groups were investigated, a case group comprised of patients with sepsis admitted to PICU and two control groups; one made up of patients admitted to PICU without sepsis and the other of healthy children. Variables included demographic, anthropometric (growth metric percentile), and clinical factors. Results: Patients were randomized into control group A (n = 12, 48%), control group B (n = 11, 44%), and the sepsis group (n = 24, 47.1%). The difference in the means of resistin levels was significant on the first, fourth, and seventh days (P < 0.0001) in the case and control group A. Means comparisons in the case and control group B revealed significant differences on the fourth and seventh day (P = 0.005 and P < 0.0001, respectively) but not on the first day (P = 0.246). The trend of resistin levels increased in the septic group (F Huynh-Feldt = 37.83, P < 0.0001). The diagnostic accuracy of resistin level was high for discriminating sepsis (area under the receiver operating characteristic curve [AUC] 0.864 [SE = 0.41]). The sensitivity was 0.824 and specificity 0.72 with a cut-off point of 5.2 ng/ml on the first day. Conclusion: In the present study, resistin level can be used as an indicator of sepsis in children admitted to PICU. However, the cut-off point based upon when a prediction could be made is different and is dependent on a variety of factors, such as control group and number of days since the first signs of sepsis.