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Diagnostics
Special Issues
Prediction and Diagnosis of Sepsis
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Prediction and Diagnosis of Sepsis

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 7952

Special Issue Editor

Dr. Stefan Felix Ehrentraut

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Guest Editor
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
Interests: sepsis; ECMO; ARDS; mortality prediction; outcome analysis; intensive care

Special Issue Information

Dear Colleagues, 

Despite constant advances in the understanding of underlying disease mechanisms, sepsis and systemic inflammatory response syndrome maintain a high mortality and lead to immense healthcare costs. Early diagnostic and rapid treatment of the underlying focus are key to successfully overcoming these life-threatening problems. To achieve this, new approaches to diagnose sepsis in a timely manner and to predict its outcome are needed, both to advance basic science’s understanding of the underlying pathways and to provide clinicians with novel tools for prediction and objective decision making while treating septic patients.

The scope of this Special Issue is to present both clinical and preclinical work focused on a better understanding of underlying disease mechanisms and provide novel diagnostic approaches to allow for early detection of septic patients. Model-based decision making using biomarkers or other clinical parameters, gathered by “data mining” from big clinical data sets is gaining traction in terms of predicting outcomes. Furthermore, new insights into pathogen identification using novel approaches for diagnostics are welcome.

To this end, we encourage submissions of original articles regarding novel pathways, new biomarkers for early detection of sepsis, and prediction models for mortality or other related outcomes to this Special Issue. Reviews highlighting the use of novel biomarkers or prediction models are also welcome.

Case reports or case series will be considered if they provide substantial novelty in regard to clinical treatment or diagnostics of interest to clinicians.

Dr. Stefan Felix Ehrentraut
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • systemic inflammatory response syndrome
  • inflammation
  • sepsis
  • outcome prediction
  • disease markers

Published Papers (5 papers)

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12 pages, 974 KiB  
Article
Impact of the FilmArray Rapid Multiplex PCR Assay on Clinical Outcomes of Patients with Bacteremia
by Mai Okamoto, Makoto Maejima, Taichiro Goto, Takahiro Mikawa, Kazuhiro Hosaka, Yuki Nagakubo, Yosuke Hirotsu, Kenji Amemiya, Hitomi Sueki and Masao Omata
Diagnostics 2023, 13(11), 1935; https://doi.org/10.3390/diagnostics13111935 - 01 Jun 2023
Viewed by 1263
Abstract
Bacteremia is a serious disease with a reported mortality of 30%. Appropriate antibiotic use with a prompt blood culture can improve patient survival. However, when bacterial identification tests based on conventional biochemical properties are used, it takes 2 to 3 days from positive [...] Read more.
Bacteremia is a serious disease with a reported mortality of 30%. Appropriate antibiotic use with a prompt blood culture can improve patient survival. However, when bacterial identification tests based on conventional biochemical properties are used, it takes 2 to 3 days from positive blood culture conversion to reporting the results, which makes early intervention difficult. Recently, FilmArray (FA) multiplex PCR panel for blood culture identification was introduced to the clinical setting. In this study, we investigated the clinical impact of the FA system on decision making for treating septic diseases and its association with patients’ survival. Our hospital introduced the FA multiplex PCR panel in July 2018. In this study, blood-culture-positive cases submitted between January and October 2018 were unbiasedly included, and clinical outcomes before and after the introduction of FA were compared. The outcomes included (i) the duration of use of broad-spectrum antibiotics, (ii) the time until the start of anti-MRSA therapy to MRSA bacteremia, and (iii) sixty-day overall survival. In addition, multivariate analysis was used to identify prognostic factors. In the FA group, overall, 122 (87.8%) microorganisms were concordantly retrieved with the FA identification panel. The duration of ABPC/SBT use and the start-up time of anti-MRSA therapy to MRSA bacteremia were significantly shorter in the FA group. Sixty-day overall survival was significantly improved by utilizing FA compared with the control group. In addition, multivariate analysis identified Pitt score, Charlson score, and utilization of FA as prognostic factors. In conclusion, FA can lead to the prompt bacterial identification of bacteremia and its effective treatment, thus significantly improving survival in patients with bacteremia. Full article
(This article belongs to the Special Issue Prediction and Diagnosis of Sepsis)
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11 pages, 512 KiB  
Article
The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis
by Louisa Nitsch, Stefan Felix Ehrentraut, Marcus Grobe-Einsler, Felix J. Bode, Mohammed Banat, Matthias Schneider, Felix Lehmann, Julian Zimmermann and Johannes Weller
Diagnostics 2023, 13(7), 1313; https://doi.org/10.3390/diagnostics13071313 - 31 Mar 2023
Viewed by 1543
Abstract
Community-acquired bacterial meningitis conveys significant morbidity and mortality due to intracranial and systemic complications, and sepsis is a major contributor to the latter. While cerebrospinal fluid (CSF) analysis is essential in the diagnosis of bacterial meningitis, its predictive utility for detection of sepsis [...] Read more.
Community-acquired bacterial meningitis conveys significant morbidity and mortality due to intracranial and systemic complications, and sepsis is a major contributor to the latter. While cerebrospinal fluid (CSF) analysis is essential in the diagnosis of bacterial meningitis, its predictive utility for detection of sepsis is unknown. We investigated the diagnostic performance of CSF parameters for sepsis defined by the Sepsis-3 criteria in a retrospective cohort of patients with community-acquired bacterial meningitis. Among 103 patients, 69.5% developed sepsis. CSF lactate was associated with sepsis with an odds ratio of 1.11 (p = 0.022), while CSF cell counts, glucose and protein levels were not (all p > 0.4). Employing the optimal cutoff of 8.2 mmol/L, elevated CSF lactate resulted in a sensitivity of 81.5% and specificity of 61.5% for sepsis. In exploratory analyses, CSF lactate was also associated with in-hospital mortality with an odds ratio of 1.21 (p = 0.011). Elevated CSF lactate might contribute to early diagnosis of sepsis as well as prognostication in patients with community-acquired bacterial meningitis. Full article
(This article belongs to the Special Issue Prediction and Diagnosis of Sepsis)
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12 pages, 1708 KiB  
Article
Infection with SARS-CoV-2 Is Associated with Elevated Levels of IP-10, MCP-1, and IL-13 in Sepsis Patients
by Tanja Eichhorn, Silke Huber, René Weiss, Marie Ebeyer-Masotta, Lucia Lauková, Robert Emprechtinger, Rosa Bellmann-Weiler, Ingo Lorenz, Judith Martini, Markus Pirklbauer, Dorothea Orth-Höller, Reinhard Würzner and Viktoria Weber
Diagnostics 2023, 13(6), 1069; https://doi.org/10.3390/diagnostics13061069 - 11 Mar 2023
Cited by 1 | Viewed by 1884
Abstract
Immunothrombosis, an excessive inflammatory response with simultaneous overactivation of the coagulation system, is a central pathomechanism in sepsis and COVID-19. It is associated with cellular activation, vascular damage, and microvascular thrombosis, which can lead to multiple organ failure and death. Here, we characterized [...] Read more.
Immunothrombosis, an excessive inflammatory response with simultaneous overactivation of the coagulation system, is a central pathomechanism in sepsis and COVID-19. It is associated with cellular activation, vascular damage, and microvascular thrombosis, which can lead to multiple organ failure and death. Here, we characterized factors related to immunothrombosis in plasma samples from 78 sepsis patients. In the course of routine clinical testing, SARS-CoV-2 was detected in 14 of these patients. Viral infection was associated with a higher mortality. Both, COVID-19 negative and COVID-19 positive sepsis patients showed increased levels of effectors of immunothrombosis, including platelet factor 4, D-dimer, nucleosomes, citrullinated histone H3, high mobility group box-1 protein, as well as phosphatidylserine-expressing platelet-derived extracellular vesicles, compared to healthy controls (n = 25). Using a 27-plex cytokine bead array, we found that Interleukin (IL)-1ra, IL-6, IL-8, IL-13, tumor necrosis factor (TNF)-α, interferon inducible protein (IP)-10, monocyte chemotactic protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, and granulocyte-colony stimulating factor (G-CSF) were elevated in both, COVID-19 negative and COVID-19 positive sepsis patients, as compared to healthy controls. SARS-CoV-2 infection was associated with elevated levels of IP-10, MCP-1, and IL-13, while all other mediators widely overlapped between COVID-19 negative and COVID-19 positive patients. Full article
(This article belongs to the Special Issue Prediction and Diagnosis of Sepsis)
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15 pages, 1491 KiB  
Article
Predicting Bacteremia among Septic Patients Based on ED Information by Machine Learning Methods: A Comparative Study
by Vivian Goh, Yu-Jung Chou, Ching-Chi Lee, Mi-Chia Ma, William Yu Chung Wang, Chih-Hao Lin and Chih-Chia Hsieh
Diagnostics 2022, 12(10), 2498; https://doi.org/10.3390/diagnostics12102498 - 15 Oct 2022
Viewed by 1665
Abstract
Introduction: Bacteremia is a common but life-threatening infectious disease. However, a well-defined rule to assess patient risk of bacteremia and the urgency of blood culture is lacking. The aim of this study is to establish a predictive model for bacteremia in septic patients [...] Read more.
Introduction: Bacteremia is a common but life-threatening infectious disease. However, a well-defined rule to assess patient risk of bacteremia and the urgency of blood culture is lacking. The aim of this study is to establish a predictive model for bacteremia in septic patients using available big data in the emergency department (ED) through logistic regression and other machine learning (ML) methods. Material and Methods: We conducted a retrospective cohort study at the ED of National Cheng Kung University Hospital in Taiwan from January 2015 to December 2019. ED adults (≥18 years old) with systemic inflammatory response syndrome and receiving blood cultures during the ED stay were included. Models I and II were established based on logistic regression, both of which were derived from support vector machine (SVM) and random forest (RF). Net reclassification index was used to determine which model was superior. Results: During the study period, 437,969 patients visited the study ED, and 40,395 patients were enrolled. Patients diagnosed with bacteremia accounted for 7.7% of the cohort. The area under the receiver operating curve (AUROC) in models I and II was 0.729 (95% CI, 0.718–0.740) and 0.731 (95% CI, 0.721–0.742), with Akaike information criterion (AIC) of 16,840 and 16,803, respectively. The performance of model II was superior to that of model I. The AUROC values of models III and IV in the validation dataset were 0.730 (95% CI, 0.713–0.747) and 0.705 (0.688–0.722), respectively. There is no statistical evidence to support that the performance of the model created with logistic regression is superior to those created by SVM and RF. Discussion: The advantage of the SVM or RF model is that the prediction model is more elastic and not limited to a linear relationship. The advantage of the LR model is that it is easy to explain the influence of the independent variable on the response variable. These models could help medical staff identify high-risk patients and prevent unnecessary antibiotic use. The performance of SVM and RF was not inferior to that of logistic regression. Conclusions: We established models that provide discrimination in predicting bacteremia among patients with sepsis. The reported results could inspire researchers to adopt ML in their development of prediction algorithms. Full article
(This article belongs to the Special Issue Prediction and Diagnosis of Sepsis)
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3 pages, 315 KiB  
Comment
Dealing with the Problem of Monotone Likelihood in the Inflation of Estimated Effects in Clinical Studies. Comment on Hasegawa et al. Impact of Blood Type O on Mortality of Sepsis Patients: A Multicenter Retrospective Observational Study. Diagnostics 2020, 10, 826
by I-Shiang Tzeng
Diagnostics 2022, 12(10), 2295; https://doi.org/10.3390/diagnostics12102295 - 23 Sep 2022
Cited by 3 | Viewed by 825
Abstract
I read the press article from the Fujita Health University School of Medicine titled “Impact of Blood Type O on Mortality of Sepsis Patients: A Multicenter Retrospective Observational Study” [...] Full article
(This article belongs to the Special Issue Prediction and Diagnosis of Sepsis)
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