Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study
Purpose There is limited knowledge on how the source of infection impacts the host response to sepsis. We aimed to compare the host response in sepsis patients with a single, known source at admission (< 24 h) to the intensive care unit. Methods From the molecular diagnosis and risk stratificati...
| Main Authors: | , , , , , , , , |
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| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
Springer
2021
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| _version_ | 1797076939161206784 |
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| author | Peters-Sengers, H Butler, JM Uhel, F Schultz, MJ Bonten, MJ Cremer, OL Scicluna, BP van Vught, LA van der Poll, T |
| author2 | MARS consortium |
| author_facet | MARS consortium Peters-Sengers, H Butler, JM Uhel, F Schultz, MJ Bonten, MJ Cremer, OL Scicluna, BP van Vught, LA van der Poll, T |
| author_sort | Peters-Sengers, H |
| collection | OXFORD |
| description | Purpose
There is limited knowledge on how the source of infection impacts the host response to sepsis. We aimed to compare the host response in sepsis patients with a single, known source at admission (< 24 h) to the intensive care unit.
Methods
From the molecular diagnosis and risk stratification of sepsis (MARS) prospective cohort, we measured 16 plasma host response biomarkers reflective of key host response pathways in 621 sepsis patients. In a subgroup (n = 335), blood leukocyte transcriptomes were compared between the sources. Differences in clinical patient profiles and survival were compared in the whole sepsis cohort (n = 2019).
Results
The plasma biomarker cohort was categorized into sepsis originating from the respiratory tract (n = 334, 53.8%), abdomen (n = 159, 25.6%), urinary tract (n = 44, 7.1%), cardiovascular (n = 41, 6.6%), central nervous system (CNS) (n = 18, 2.9%), or skin (n = 25, 4%). This analysis revealed stronger inflammatory and cytokine responses, loss of vascular integrity and coagulation activation in abdominal sepsis relative to respiratory. Endothelial cell activation was prominent in urinary, cardiovascular and skin infections, while CNS infection was associated with the least host response aberrations. The leukocyte transcriptional response showed the largest overlap between abdominal and pulmonary infections (76% in common); notable differences between the sources were detected regarding hemostasis, cytokine signaling, innate and adaptive immune, and metabolic transcriptional pathways. After adjustment for confounders, the source of infection remained an independent contributor to 30-day mortality (unadjusted p = 0.001, adjusted p = 0.028).
Conclusion
Sepsis heterogeneity is partly explained by source-specific host response dysregulations and should be considered when selecting patients for trials testing immune modulatory drugs.
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| first_indexed | 2024-03-07T00:10:43Z |
| format | Journal article |
| id | oxford-uuid:79244671-3815-4de2-acc8-672c2f7e202b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:10:43Z |
| publishDate | 2021 |
| publisher | Springer |
| record_format | dspace |
| spelling | oxford-uuid:79244671-3815-4de2-acc8-672c2f7e202b2022-03-26T20:35:30ZSource-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:79244671-3815-4de2-acc8-672c2f7e202bEnglishSymplectic ElementsSpringer2021Peters-Sengers, HButler, JMUhel, FSchultz, MJBonten, MJCremer, OLScicluna, BPvan Vught, LAvan der Poll, TMARS consortiumPurpose There is limited knowledge on how the source of infection impacts the host response to sepsis. We aimed to compare the host response in sepsis patients with a single, known source at admission (< 24 h) to the intensive care unit. Methods From the molecular diagnosis and risk stratification of sepsis (MARS) prospective cohort, we measured 16 plasma host response biomarkers reflective of key host response pathways in 621 sepsis patients. In a subgroup (n = 335), blood leukocyte transcriptomes were compared between the sources. Differences in clinical patient profiles and survival were compared in the whole sepsis cohort (n = 2019). Results The plasma biomarker cohort was categorized into sepsis originating from the respiratory tract (n = 334, 53.8%), abdomen (n = 159, 25.6%), urinary tract (n = 44, 7.1%), cardiovascular (n = 41, 6.6%), central nervous system (CNS) (n = 18, 2.9%), or skin (n = 25, 4%). This analysis revealed stronger inflammatory and cytokine responses, loss of vascular integrity and coagulation activation in abdominal sepsis relative to respiratory. Endothelial cell activation was prominent in urinary, cardiovascular and skin infections, while CNS infection was associated with the least host response aberrations. The leukocyte transcriptional response showed the largest overlap between abdominal and pulmonary infections (76% in common); notable differences between the sources were detected regarding hemostasis, cytokine signaling, innate and adaptive immune, and metabolic transcriptional pathways. After adjustment for confounders, the source of infection remained an independent contributor to 30-day mortality (unadjusted p = 0.001, adjusted p = 0.028). Conclusion Sepsis heterogeneity is partly explained by source-specific host response dysregulations and should be considered when selecting patients for trials testing immune modulatory drugs. |
| spellingShingle | Peters-Sengers, H Butler, JM Uhel, F Schultz, MJ Bonten, MJ Cremer, OL Scicluna, BP van Vught, LA van der Poll, T Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study |
| title | Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study |
| title_full | Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study |
| title_fullStr | Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study |
| title_full_unstemmed | Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study |
| title_short | Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study |
| title_sort | source specific host response and outcomes in critically ill patients with sepsis a prospective cohort study |
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