Journal Article Epublish 1 citation
PubMed: 39559359 DOI: 10.3389/fimmu.2024.1447523
Assessing sepsis-induced immunosuppression to predict positive blood cultures.
Front Immunol 15:1447523
Authors: Enrique Hernández-Jiménez, Erika P Plata-Menchaca, Damaris Berbel, Guillem López de Egea, Macarena Dastis-Arias, Laura García-Tejada, Fabrizio Sbraga, Pierre Malchair, Nadia García Muñoz, Alejandra Larrad Blasco, Eva Molina Ramírez, Xose Pérez Fernández, Joan Sabater Riera, Arnau Ulsamer
Affiliations
- R&D Department, Loop Diagnostics, Barcelona, Spain. Servei de Medicina Intensiva, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain.
- Servei de Medicina Intensiva, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain. Vall d'Hebron Research Institute (VHIR), Vall d´Hebron Hospital Campus, Barcelona, Spain.
- Departament de Microbiologia, Hospital Universitari de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain.
- Research Network for Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
- Division of Emergency Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
- Biochemistry Core of the Clinical Laboratory, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
- Servei de Cirurgia Cardíaca, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
- Departament d'urgències, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
- Banc de sang i teixits, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
- Servei de Medicina Intensiva, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain.
Abstract
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 [TNFα], IL-1β, IL-6, IL-8, and IL-10) were measured. Patients with positive blood cultures exhibited significantly lower TNFα 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.
MeSH
Cytokines, Bacteremia, Blood, Biomarkers, Immune System Diseases, Sepsis, Diagnosis, Blood Culture, Endotoxins, Immunosuppression Therapy, Endotoxin Tolerance