在 ICU 中诊断脓毒症：基因表达特征与现有生物标志物的比较。

Diagnosing sepsis in the ICU: Comparison of a gene expression signature to pre-existing biomarkers.

机构信息

Department of Intensive Care, Gold Coast University Hospital, Southport, Queensland, Australia; University of Queensland, St Lucia, Queensland, Australia.

Genomics Research Centre, Centre for Genomics and Personalised Health, School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia.

出版信息

J Crit Care. 2023 Aug;76:154286. doi: 10.1016/j.jcrc.2023.154286. Epub 2023 Mar 23.

DOI:10.1016/j.jcrc.2023.154286

PMID:36965223

Abstract

PURPOSE

We aimed to identify a gene signature that discriminates between sepsis and aseptic inflammation in patients administered antibiotics in the intensive care unit and compare it to commonly utilised sepsis biomarkers.

METHODS

91 patients commenced on antibiotics were retrospectively diagnosed as having: (i) blood culture positive sepsis; (ii) blood culture negative sepsis; or (iii) aseptic inflammation. Bloods were collected after <24 h of antibiotic commencement for both gene expression sequencing analysis and measurement of previously identified biomarkers.

RESULTS

53 differentially expressed genes were identified that accurately discriminated between blood culture positive sepsis and aseptic inflammation in a cohort of patients given antibiotics [aROC 0.97 (95% CI, 0.95-0.99)]. This gene signature was validated in a publicly available database. The gene signature outperformed previously identified sepsis biomarkers including C-reactive protein [aROC 0.72 (95% CI, 0.57-0.87)], NT-Pro B-type Natriuretic Peptide [aROC 0.84 (95% CI, 0.73-0.96)], and Septicyte™ LAB [aROC 0.8 (95% CI, 0.68-0.93)], but was comparable to Procalcitonin [aROC 0.96 (95% CI, 0.9-1)].

CONCLUSIONS

A gene expression signature was identified that accurately discriminates between sepsis and aseptic inflammation in patients given antibiotics in the intensive care unit.

摘要

目的

我们旨在确定一种基因特征，以区分在重症监护病房接受抗生素治疗的患者中的脓毒症和无菌性炎症，并将其与常用的脓毒症生物标志物进行比较。

方法

回顾性诊断 91 名接受抗生素治疗的患者患有：（i）血培养阳性脓毒症；（ii）血培养阴性脓毒症；或（iii）无菌性炎症。在开始使用抗生素后 <24 小时采集血液，用于基因表达测序分析和测量先前确定的生物标志物。

结果

在接受抗生素治疗的患者队列中，鉴定出 53 个差异表达的基因，可准确区分血培养阳性脓毒症和无菌性炎症[aROC 0.97（95%CI，0.95-0.99)]。该基因特征在公开可用的数据库中得到验证。该基因特征优于先前确定的脓毒症生物标志物，包括 C 反应蛋白[aROC 0.72（95%CI，0.57-0.87)]、N 端 B 型利钠肽前体[ aROC 0.84（95%CI，0.73-0.96)]和 Septicyte™LAB[aROC 0.8（95%CI，0.68-0.93)]，但与降钙素原相当[aROC 0.96（95%CI，0.9-1)]。