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Llitjos JF, Carrol ED, Osuchowski MF, Bonneville M, Scicluna BP, Payen D, Randolph AG, Witte S, Rodriguez-Manzano J, François B. Enhancing sepsis biomarker development: key considerations from public and private perspectives. Crit Care 2024; 28:238. [PMID: 39003476 PMCID: PMC11246589 DOI: 10.1186/s13054-024-05032-9] [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: 05/03/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024] Open
Abstract
Implementation of biomarkers in sepsis and septic shock in emergency situations, remains highly challenging. This viewpoint arose from a public-private 3-day workshop aiming to facilitate the transition of sepsis biomarkers into clinical practice. The authors consist of international academic researchers and clinician-scientists and industry experts who gathered (i) to identify current obstacles impeding biomarker research in sepsis, (ii) to outline the important milestones of the critical path of biomarker development and (iii) to discuss novel avenues in biomarker discovery and implementation. To define more appropriately the potential place of biomarkers in sepsis, a better understanding of sepsis pathophysiology is mandatory, in particular the sepsis patient's trajectory from the early inflammatory onset to the late persisting immunosuppression phase. This time-varying host response urges to develop time-resolved test to characterize persistence of immunological dysfunctions. Furthermore, age-related difference has to be considered between adult and paediatric septic patients. In this context, numerous barriers to biomarker adoption in practice, such as lack of consensus about diagnostic performances, the absence of strict recommendations for sepsis biomarker development, cost and resources implications, methodological validation challenges or limited awareness and education have been identified. Biomarker-guided interventions for sepsis to identify patients that would benefit more from therapy, such as sTREM-1-guided Nangibotide treatment or Adrenomedullin-guided Enibarcimab treatment, appear promising but require further evaluation. Artificial intelligence also has great potential in the sepsis biomarker discovery field through capability to analyse high volume complex data and identify complex multiparametric patient endotypes or trajectories. To conclude, biomarker development in sepsis requires (i) a comprehensive and multidisciplinary approach employing the most advanced analytical tools, (ii) the creation of a platform that collaboratively merges scientific and commercial needs and (iii) the support of an expedited regulatory approval process.
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Affiliation(s)
- Jean-Francois Llitjos
- Open Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy l'Etoile, France.
- Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
| | - Enitan D Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool Institute of Infection Veterinary and Ecological Sciences, Liverpool, UK
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Marcin F Osuchowski
- Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation with AUVA, Vienna, Austria
| | - Marc Bonneville
- Medical and Scientific Affairs, Institut Mérieux, Lyon, France
| | - Brendon P Scicluna
- Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Hospital, University of Malta, Msida, Malta
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Didier Payen
- Paris 7 University Denis Diderot, Paris Sorbonne, Cité, France
| | - Adrienne G Randolph
- Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | | | - Bruno François
- Medical-Surgical Intensive Care Unit, Réanimation Polyvalente, Dupuytren University Hospital, CHU de Limoges, 2 Avenue Martin Luther King, 87042, Limoges Cedex, France.
- Inserm CIC 1435, Dupuytren University Hospital, Limoges, France.
- Inserm UMR 1092, Medicine Faculty, University of Limoges, Limoges, France.
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Khashaba MA, Abdelal IF, Abd El Rahman SM, Abdel Rahman MH. Sequential estimation of the national early warning score-2 and SERUM PRESEPSIN might discriminate sepsis patients who were vulnerable to death in surgical ICU. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2125249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Mohamed A. Khashaba
- Department of Anesthesia, Pain & ICU, Faculty of Medicine, Benha University, Benha, Egypt
| | - Inas F. Abdelal
- Department of Anesthesia, Pain & ICU, Faculty of Medicine, Cairo University, Giza, Egypt
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Nam M, Hur M, Kim H, Lee GH, Park M, Kwon HS, Hwang HS, Sohn IS. Distribution of Presepsin, Krebs von den Lungen 6, and Surfactant Protein A in Umbilical Cord Blood. Diagnostics (Basel) 2022; 12:diagnostics12092213. [PMID: 36140614 PMCID: PMC9498084 DOI: 10.3390/diagnostics12092213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Abstract
Presepsin is an early indicator of infection, and Krebs von den Lungen 6 (KL-6) and Surfactant Protein A (SP-A) are related to the pathogenesis of pulmonary infection and fibrosis. This study aimed to establish reference intervals (RIs) of presepsin, KL-6, and SP-A levels and to evaluate the possible influence of neonatal and maternal factors on presepsin, KL-6, and SP-A levels in umbilical cord blood (UCB). Among a total of 613 UCB samples, the outliers were removed. The RIs for presepsin, KL-6, and SP-A levels were defined using non-parametric percentile methods according to the Clinical and Laboratory Standards Institute guidelines (EP28-A3C). These levels were analyzed according to neonatal and maternal factors: neonatal sex, gestational age (GA), birth weight (BW), Apgar score, delivery mode, the presence of premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), and pre-eclampsia. Presepsin, KL-6, and SP-A levels showed non-parametric distributions and left-skewed histograms. The RIs of presepsin, KL-6, and SP-A levels were 64.9–428.3 pg/mL, 43.0–172.0 U/mL, and 2.1–36.1 ng/mL, respectively. Presepsin, KL-6, and SP-A levels did not show significant differences according to sex, GA, BW, Apgar score, delivery mode, PROM, GDM, and pre-eclampsia. The median level and 97.5th centile RI of KL-6 showed a slight increase with increased GA. We established RIs for presepsin, KL-6, and SP-A levels in large-scaled UCB samples. Further investigation would be needed to determine the clinical significance.
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Affiliation(s)
- Minjeong Nam
- Department of Laboratory Medicine, Korea University Anam Hospital, Seoul 02841, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-5581
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Gun-Hyuk Lee
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Mikyoung Park
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, Seoul 03312, Korea
| | - Han-Sung Kwon
- Department of Obstetrics & Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Han-Sung Hwang
- Department of Obstetrics & Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea
| | - In-Sook Sohn
- Department of Obstetrics & Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea
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Poggi C, Lucenteforte E, Petri D, De Masi S, Dani C. Presepsin for the Diagnosis of Neonatal Early-Onset Sepsis: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:750-758. [PMID: 35639395 PMCID: PMC9157383 DOI: 10.1001/jamapediatrics.2022.1647] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Neonatal early-onset sepsis (EOS) is a severe disease, particularly in preterm infants. Timely diagnosis can be challenging owing to unspecific presentation and questionable performance of the common markers of infection. Presepsin was recently proven to be a promising biomarker for the diagnosis of EOS. OBJECTIVE To assess presepsin accuracy for the diagnosis of EOS. DATA SOURCES PubMed Medline, EMBASE, Web of Science, and Google Scholar. No publication date restrictions were applied. The literature search was limited to the English language. Articles were checked for duplication. STUDY SELECTION Inclusion criteria were studies that (1) included term or preterm newborns (defined as newborns with gestational age ≥37 weeks or <37 weeks, respectively); (2) included a diagnosis of EOS, defined as culture-proven sepsis for primary analysis and as either clinical or culture-proven sepsis for secondary analysis; and (3) assessed presepsin values during the initial workup for suspected EOS. Exclusion criteria were studies that (1) did not include EOS cases; (2) lacked data on presepsin sensitivity and/or specificity; and (3) were case reports, commentaries, or reviews. Two independent reviewers performed the study selection. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed data extraction and quality assessment. Quality assessment was performed using the Quality Assessment for Studies of Diagnostic Accuracy 2 tool, and data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES The outcomes of interest for both the primary and secondary analyses were presepsin sensitivity, specificity, and diagnostic odds ratio for the diagnosis of EOS. RESULTS A total of 12 studies of 245 (4.9%) met inclusion criteria for the primary analysis. Twenty-three studies of 245 (9.4%) met the inclusion criteria for the secondary analysis. In the primary analysis, among 12 studies and 828 newborns of any gestational age, pooled sensitivity and specificity were 0.93 (95% CI, 0.86-0.95) and 0.91 (95% CI, 0.85-0.95), respectively; pooled diagnostic odds ratio was 131.69 (95% CI, 54.93-310.94). Subgroup analysis showed that presepsin specificity was associated with the inclusion of only EOS or all neonatal sepsis. Presepsin accuracy was not associated with gestational age, measurement with chemiluminescence enzyme immunoassay or enzyme-linked immunosorbent assay testing, country where the study was performed, or risk of bias judgment. In the secondary analysis, among 23 studies and 1866 newborns, accuracy was significantly associated with only test type. CONCLUSIONS AND RELEVANCE Results of this systematic review and meta-analysis suggest that presepsin was an accurate biomarker of EOS. Clinical trials are warranted to assess its usefulness and safety to reduce early antibiotic exposure, particularly in preterm newborns.
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Affiliation(s)
- Chiara Poggi
- Neonatology and Neonatal Intensive Care, Department of Mother and Child Care, Careggi University Hospital, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Carlo Dani
- Neonatology and Neonatal Intensive Care, Department of Mother and Child Care, Careggi University Hospital, Florence, Italy,Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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Maddaloni C, De Rose DU, Santisi A, Martini L, Caoci S, Bersani I, Ronchetti MP, Auriti C. The Emerging Role of Presepsin (P-SEP) in the Diagnosis of Sepsis in the Critically Ill Infant: A Literature Review. Int J Mol Sci 2021; 22:ijms222212154. [PMID: 34830040 PMCID: PMC8620326 DOI: 10.3390/ijms222212154] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022] Open
Abstract
Sepsis causes high rates of morbidity and mortality in NICUs. The estimated incidence varies between 5 and 170 per 1000 births, depending on the social context. In very low birth-weight neonates, the level of mortality increases with the duration of hospitalization, reaching 36% among infants aged 8-14 days and 52% among infants aged 15-28 days. Early diagnosis is the only tool to improve the poor prognosis of neonatal sepsis. Blood culture, the gold standard for diagnosis, is time-consuming and poorly sensitive. C-reactive protein and procalcitonin, currently used as sepsis biomarkers, are influenced by several maternal and fetal pro-inflammatory conditions in the perinatal age. Presepsin is the N-terminal fragment of soluble CD14 subtype (sCD14-ST): it is released in the bloodstream by monocytes and macrophages, in response to bacterial invasion. Presepsin seems to be a new, promising biomarker for the early diagnosis of sepsis in neonates as it is not modified by perinatal confounding inflammatory factors. The aim of the present review is to collect current knowledge about the role of presepsin in critically ill neonates.
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Affiliation(s)
- Chiara Maddaloni
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Alessandra Santisi
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Ludovica Martini
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Stefano Caoci
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Iliana Bersani
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
- Neonatal Intensive Care (NICU) and Neonatal Pathology, San Vincenzo Hospital, 98039 Taormina, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
- Correspondence: ; Tel.: +39-06-6859-2427; Fax: +39-06-6859-3916
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Biomarkers for Point-of-Care Diagnosis of Sepsis. MICROMACHINES 2020; 11:mi11030286. [PMID: 32164268 PMCID: PMC7143187 DOI: 10.3390/mi11030286] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 12/18/2022]
Abstract
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. In 2017, almost 50 million cases of sepsis were recorded worldwide and 11 million sepsis-related deaths were reported. Therefore, sepsis is the focus of intense research to better understand the complexities of sepsis response, particularly the twin underlying concepts of an initial hyper-immune response and a counter-immunological state of immunosuppression triggered by an invading pathogen. Diagnosis of sepsis remains a significant challenge. Prompt diagnosis is essential so that treatment can be instigated as early as possible to ensure the best outcome, as delay in treatment is associated with higher mortality. In order to address this diagnostic problem, use of a panel of biomarkers has been proposed as, due to the complexity of the sepsis response, no single marker is sufficient. This review provides background on the current understanding of sepsis in terms of its epidemiology, the evolution of the definition of sepsis, pathobiology and diagnosis and management. Candidate biomarkers of interest and how current and developing point-of-care testing approaches could be used to measure such biomarkers is discussed.
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