ORIGINAL ARTICLES

Quantification of Immune Dysregulation by Next-generation Polymerase Chain Reaction to Improve Sepsis Diagnosis in Surgical Patients

Almansa, Raquel PhD^∗; Ortega, Alicia MLT^∗; Ávila-Alonso, Ana B.Pharm^∗; Heredia-Rodríguez, Maria MD, PhD^†; Martín, Silvia MD^‡; Benavides, Diana MD^§; Martín-Fernandez, Marta MSc^∗; Rico, Lucia MLT^∗; Aldecoa, César MD, PhD^‡; Rico, Jesús MD, PhD^‡; López de Cenarruzabeitia, Iñigo MD, PhD^§; Beltrán de Heredia, Juan MD, PhD^§; Gomez-Sanchez, Esther MD, PhD^†; Aragón, Marta MD^†; Andrés, Cristina B.Pharm^¶; Calvo, Dolores MD^¶; Andaluz-Ojeda, David MD, PhD^||; Liu, Pilar MD^†; Blanco-Antona, Francisco MD^§; Blanco, Lydia MD, PhD^∗∗; Gómez-Herreras, Jose Ignacio MD, PhD^†; Tamayo, Eduardo MD, PhD^†; Bermejo-Martin, Jesus F. MD, PhD^∗

Author Information

^∗Group for Biomedical Research in Sepsis (Bio Sepsis), Hospital Clínico Universitario de Valladolid/IECSCYL, Valladolid, Spain

^†Anesthesiology and Reanimation Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

^‡Anesthesiology and Reanimation Service, Hospital Universitario Río Hortega, Valladolid, Spain

^§General Surgery Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

^¶Clinical Analysis Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

^||Intensive Care Medicine Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain

^∗∗Center for Hemodonation and Hemotherapy of Castilla y León (CHEMCYL), León, Spain.

Reprints: Jesus F. Bermejo-Martin, MD, PhD, Group for Biomedical Research in Sepsis (Bio Sepsis), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, Avda Ramón y Cajal 3, 47005 Valladolid, Spain; E-mail: [email protected].

The study was supported by the “Instituto de Salud Carlos III” and “Consejeria de Sanidad de Castilla y Leon” for their financial support, grant numbers (EMER 07/050), (PI13/02110), (PI 15/01451), and (PI16/01156).

The authors report no conflicts of interests.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

Annals of Surgery 269(3):p 545-553, March 2019. | DOI: 10.1097/SLA.0000000000002406

Abstract

Objectives:

To quantify immunological dysfunction in surgical patients with presence/absence of sepsis using a droplet digital polymerase chain reaction (ddPCR) transcriptomic analysis. The study also aims to evaluate this approach for improving identification of sepsis in these patients.

Background:

Immune dysregulation is a central event in sepsis. Quantification of the expression of immunological genes participating in the pathogenesis of sepsis could represent a new avenue to improve its diagnosis.

Methods:

Expression of 6 neutrophil protease genes (MMP8, OLFM4, LCN2/NGAL, LTF, PRTN3, MPO) and also of 5 genes involved in the immunological synapse (HLA-DRA, CD40LG, CD3E, CD28, ICOS) was quantified in blood from 101 surgical patients with sepsis, 53 uninfected surgical patients, and 16 blood donors by using ddPCR. Areas under receiver operating characteristic curves (AUROC) and multivariate regression analysis were employed to test individual genes and gene ratios to identify sepsis, in comparison with procalcitonin.

Results:

Sepsis-induced overexpression of neutrophil protease genes and depressed expression of immunological synapse genes. MMP8/HLA-DRA, LCN2/HLA-DRA outperformed procalcitonin in differentiating between patients with sepsis and surgical controls in the AUROC analysis: LCN2/HLA-DRA: 0.90 (0.85–0.96), MMP8/HLA-DRA: 0.89 (0.84–0.95), procalcitonin: 0.80 (0.73–0.88) (AUROC, confidence interval 95%), and also in the multivariate analysis: LCN2/HLA-DRA: 8.57 (2.25–32.62); MMP8/HLA-DRA: 8.03 (2.10–30.76), procalcitonin: 4.20 (1.15–15.43) [odds ratio (confidence interval 95%)]. Gene expression levels of HLA-DRA were an independent marker of hospital mortality.

Conclusions:

Quantifying the transcriptomic ratios MMP8/HLA-DRA, LCN2/HLA-DRA by ddPCR is a promising approach to improve sepsis diagnosis in surgical patients.

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Quantification of Immune Dysregulation by Next-generation Polymerase Chain Reaction to Improve Sepsis Diagnosis in Surgical Patients