Assessing sepsis-induced immunosuppression to predict positive blood cultures

被引:1
作者
Hernandez-Jimenez, Enrique [1 ,2 ]
Plata-Menchaca, Erika P. [2 ,3 ]
Berbel, Damaris [4 ,5 ]
de Egea, Guillem Lopez [4 ,5 ]
Dastis-Arias, Macarena [6 ]
Garcia-Tejada, Laura [7 ]
Sbraga, Fabrizio [8 ]
Malchair, Pierre [9 ]
Munoz, Nadia Garcia [10 ]
Blasco, Alejandra Larrad [2 ]
Ramirez, Eva Molina [2 ]
Fernandez, Xose Perez [2 ]
Riera, Joan Sabater [2 ]
Ulsamer, Arnau [2 ]
机构
[1] Loop Diagnost, R&D Dept, Barcelona, Spain
[2] Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge IDIBELL, Serv Med Intens, Lhospitalet De Llobregat, Spain
[3] Vall dHebron Hosp Campus, Vall dHebron Res Inst VHIR, Barcelona, Spain
[4] Hosp Univ Bellvitge IDIBELL, Dept Microbiol, Lhospitalet De Llobregat, Spain
[5] Inst Salud Carlos III, Res Network Resp Dis CIBERES, Madrid, Spain
[6] Hosp Univ Bellvitge, Div Emergency Lab, Lhospitalet De Llobregat, Spain
[7] Hosp Univ Bellvitge, Biochem Core Clin Lab, Lhospitalet De Llobregat, Spain
[8] Hosp Univ Bellvitge, Serv Cirurg Cardiaca, Lhospitalet De Llobregat, Spain
[9] Hosp Univ Bellvitge, Dept Urgencies, Lhospitalet De Llobregat, Spain
[10] Hosp Univ Bellvitge, Banc Sang & Teixits, Lhospitalet De Llobregat, Spain
来源
FRONTIERS IN IMMUNOLOGY | 2024年 / 15卷
关键词
bacteremia; sepsis; endotoxin tolerance; immunosuppression; blood culture; TNF alpha; LPS; biomarkers; ENDOTOXIN TOLERANCE; STREAM INFECTION; SEPTIC PATIENTS; IMMUNOPARALYSIS; DYSFUNCTION; MORTALITY; DIAGNOSIS; OUTCOMES; SHOCK;
D O I
10.3389/fimmu.2024.1447523
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Introduction Bacteremia is a life-threatening condition that can progress to sepsis and septic shock, leading to significant mortality in the emergency department (ED). The standard diagnostic method, blood culture, is time-consuming and prone to false positives and false negatives. Although not widely accepted, several clinical and artificial intelligence-based algorithms have been recently developed to predict bacteremia. However, these strategies require further identification of new variables to improve their diagnostic accuracy. This study proposes a novel strategy to predict positive blood cultures by assessing sepsis-induced immunosuppression status through endotoxin tolerance assessment.Methods Optimal assay conditions have been explored and tested in sepsis-suspected patients meeting the Sepsis-3 criteria. Blood samples were collected at ED admission, and endotoxin (lipopolysaccharide, LPS) challenge was performed to evaluate the innate immune response through cytokine profiling.Results Clinical variables, immune cell population biomarkers, and cytokine levels (tumor necrosis factor [TNF alpha], IL-1 beta, IL-6, IL-8, and IL-10) were measured. Patients with positive blood cultures exhibited significantly lower TNF alpha production after LPS challenge than did those with negative blood cultures. The study also included a validation cohort to confirm that the response was consistent.Discussion The results of this study highlight the innate immune system immunosuppression state as a critical parameter for sepsis diagnosis. Notably, the present study identified a reduction in monocyte populations and specific cytokine profiles as potential predictive markers. This study showed that the LPS challenge can be used to effectively distinguish between patients with bloodstream infection leading to sepsis and those whose blood cultures are negative, providinga rapid and reliable diagnostic tool to predict positive blood cultures. The potential applicability of these findings could enhance clinical practice in terms of the accuracy and promptness of sepsis diagnosis in the ED, improving patient outcomes through timely and appropriate treatment.
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