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05.10.2018 | Original

Early PREdiction of sepsis using leukocyte surface biomarkers: the ExPRES-sepsis cohort study

verfasst von: Manu Shankar-Hari, Deepankar Datta, Julie Wilson, Valentina Assi, Jacqueline Stephen, Christopher J. Weir, Jillian Rennie, Jean Antonelli, Anthony Bateman, Jennifer M. Felton, Noel Warner, Kevin Judge, Jim Keenan, Alice Wang, Tony Burpee, Alun K. Brown, Sion M. Lewis, Tracey Mare, Alistair I. Roy, John Wright, Gillian Hulme, Ian Dimmick, Alasdair Gray, Adriano G. Rossi, A. John Simpson, Andrew Conway Morris, Timothy S. Walsh

Erschienen in: Intensive Care Medicine | Ausgabe 11/2018

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Abstract

Purpose

Reliable biomarkers for predicting subsequent sepsis among patients with suspected acute infection are lacking. In patients presenting to emergency departments (EDs) with suspected acute infection, we aimed to evaluate the reliability and discriminant ability of 47 leukocyte biomarkers as predictors of sepsis (Sequential Organ Failure Assessment score ≥ 2 at 24 h and/or 72 h following ED presentation).

Methods

In a multi-centre cohort study in four EDs and intensive care units (ICUs), we standardised flow-cytometric leukocyte biomarker measurement and compared patients with suspected acute infection (cohort-1) with two comparator cohorts: ICU patients with established sepsis (cohort-2), and ED patients without infection or systemic inflammation but requiring hospitalization (cohort-3).

Results

Between January 2014 and February 2016, we recruited 272, 59 and 75 patients to cohorts 1, 2, and 3, respectively. Of 47 leukocyte biomarkers, 14 were non-reliable, and 17 did not discriminate between the three cohorts. Discriminant analyses for predicting sepsis within cohort-1 were undertaken for eight neutrophil (cluster of differentiation antigens (CD) CD15; CD24; CD35; CD64; CD312; CD11b; CD274; CD279), seven monocyte (CD35; CD64; CD312; CD11b; HLA-DR; CD274; CD279) and a CD8 T-lymphocyte biomarker (CD279). Individually, only higher neutrophil CD279 [OR 1.78 (95% CI 1.23–2.57); P = 0.002], higher monocyte CD279 [1.32 (1.03–1.70); P = 0.03], and lower monocyte HLA-DR [0.73 (0.55–0.97); P = 0.03] expression were associated with subsequent sepsis. With logistic regression the optimum biomarker combination was increased neutrophil CD24 and neutrophil CD279, and reduced monocyte HLA-DR expression, but no combination had clinically relevant predictive validity.

Conclusions

From a large panel of leukocyte biomarkers, immunosuppression biomarkers were associated with subsequent sepsis in ED patients with suspected acute infection.

Clinical trial registration

NCT02188992.

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Titel: Early PREdiction of sepsis using leukocyte surface biomarkers: the ExPRES-sepsis cohort study
verfasst von: Manu Shankar-Hari
Deepankar Datta
Julie Wilson
Valentina Assi
Jacqueline Stephen
Christopher J. Weir
Jillian Rennie
Jean Antonelli
Anthony Bateman
Jennifer M. Felton
Noel Warner
Kevin Judge
Jim Keenan
Alice Wang
Tony Burpee
Alun K. Brown
Sion M. Lewis
Tracey Mare
Alistair I. Roy
John Wright
Gillian Hulme
Ian Dimmick
Alasdair Gray
Adriano G. Rossi
A. John Simpson
Andrew Conway Morris
Timothy S. Walsh
Publikationsdatum: 05.10.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 11/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5389-0

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Early PREdiction of sepsis using leukocyte surface biomarkers: the ExPRES-sepsis cohort study

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial registration

Neu im Fachgebiet AINS

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Fünf Dinge, die im Kindernotfall besser zu unterlassen sind

Hochrisiko-Eingriffe für postoperative Übelkeit

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Update AINS

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Clinical trial registration

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