von der Forst M, Back L, Tourelle K M, Gruneberg D, Weigand M A, Schmitt F C F, Dietrich Maximilian
Medical Faculty Heidelberg, Department of Anesthesiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Infection. 2025 Jun;53(3):953-965. doi: 10.1007/s15010-024-02409-4. Epub 2024 Nov 22.
Early recognition of sepsis is critical to patient outcome, with mortality increasing with every hour of delay in treatment. The aim of this study was to investigate the use of a point-of-care molecular host response assay to differentiate sepsis from inflammation after surgery.
Three molecular host response assays (SeptiCyte® RAPID) were performed in 61 patients after major abdominal surgery with admission to the intensive care unit and drawn blood cultures. The first (T0) was taken ± 3 h around the time of obtaining blood cultures, the second 24 h later (T24) and the third at discharge from the intensive care unit (Tex). The primary endpoint was the agreement of SeptiCyte® RAPID results with the diagnosis of sepsis. SeptiScore® indicates sepsis probability (low risk 0 - high risk 15). Patients were retrospectively classified into sepsis and inflammation by three blinded experts.
25 (42.4%) patients were categorized as "inflammation" and 34 (57.6%) patients as "sepsis". At T0 and T24 septic patients showed significantly higher mean SeptiScores® of 8.0 (± 2.2 SD) vs. 6.3 (± 2.1 SD) and 8.5 (± 2.1 SD) vs. 6.2 (± 1.8 SD), respectively. The Receiver Operating Curves (ROC) for the ability to discriminate between sepsis and inflammation had an Area Under the Curve (AUC) of 0.71 (T0) and 0.80 (T24).
Embedded in a comprehensive diagnostic algorithm molecular host response analysis could broaden the possibilities for infection diagnostics to differentiate between sepsis and inflammatory response after surgery. But validation in larger cohorts is needed.
早期识别脓毒症对患者预后至关重要，治疗每延迟一小时死亡率就会增加。本研究的目的是调查使用即时分子宿主反应检测来区分手术后脓毒症与炎症。
对61例接受腹部大手术并入住重症监护病房且进行血培养的患者进行了三项分子宿主反应检测（SeptiCyte® RAPID）。第一次检测（T0）在获取血培养样本的时间±3小时左右进行，第二次在24小时后（T24），第三次在重症监护病房出院时（Tex）。主要终点是SeptiCyte® RAPID检测结果与脓毒症诊断的一致性。SeptiScore®表示脓毒症概率（低风险0 - 高风险15）。由三位盲法专家对患者进行回顾性分类为脓毒症和炎症。
25例（42.4%）患者被归类为“炎症”，34例（57.6%）患者被归类为“脓毒症”。在T0和T24时，脓毒症患者的平均SeptiScores®显著更高，分别为8.0（±2.2标准差）对6.3（±2.1标准差）和8.5（±2.1标准差）对6.2（±1.8标准差）。区分脓毒症和炎症能力的受试者工作特征曲线（ROC）的曲线下面积（AUC）在T0时为0.71，在T24时为0.80。
嵌入综合诊断算法中的分子宿主反应分析可以拓宽感染诊断的可能性，以区分手术后的脓毒症和炎症反应。但需要在更大的队列中进行验证。
