Daily Sepsis Research Analysis

OBJECTIVES: To aggregate literature on the diagnostic performance of monocyte distribution width (MDW) for sepsis detection among adults in the emergency department and inpatient settings. METHODS: We searched the MEDLINE, EMBASE, SCOPUS, and Cochrane databases for studies evaluating MDW for sepsis diagnosis in adults in the hospital setting through October 19, 2024. Two authors (G.E. and Q.H.) independently performed eligibility assessment, data extraction, and risk of bias assessment. We evaluated performance for sepsis-2 and sepsis-3 separately and applied separate diagnostic thresholds depending on the anticoagulant used in blood collection. Data were pooled using a random-effects model. We performed multiple sensitivity analyses to evaluate the stability of our findings. RESULTS: Twenty-five observational studies comprising 39,041 patients were included. The area under the summary receiver operating curve (AUC) was 0.82 (95% CI, 0.78-0.85) for both sepsis-2 and sepsis-3. Sensitivity and specificity were 0.79 (95% CI, 0.74-0.83) and 0.7 (95% CI, 0.61-0.78) for sepsis-2 and 0.83 (95% CI, 0.78-0.88) and 0.64 (95% CI, 0.55-0.71) for sepsis-3. The threshold-independent weighted-average AUC was 0.76 (SD, 0.1) for sepsis-2 and 0.77 (SD, 0.07) for sepsis-3. The aggregate negative predictive value was 94% for sepsis-2 and 96% for sepsis-3. We observed similar performance across all sensitivity analyses. We assessed the overall quality of evidence to be low. CONCLUSIONS: MDW performs similarly to other biomarkers such as procalcitonin for the diagnosis of sepsis, with the unique advantage of rapid availability as part of routine testing.

INTRODUCTION: Limited data are available on the use, duration, and dosage of anticoagulant therapy in patients with pneumonia-induced sepsis, and the survival benefits of heparin remain uncertain. This study aimed to assess whether heparin administration improves near-term survival in critically ill patients with pneumonia-induced sepsis and identify the optimal dosage and treatment duration. METHODS: This study utilized the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The variance inflation factor was employed to exclude highly collinear variables. Propensity score matching (PSM), the Cox proportional hazards model, and Cox regression subgroup analysis were used to evaluate the outcomes of subcutaneous heparin prophylactic anticoagulation after intensive care unit (ICU) admission. The primary outcomes were 30-, 45-, and 60-d mortality rates. Secondary outcomes included ICU length of stay (LOS_ICU), hospital length of stay (LOS_Hospital), in-hospital mortality, and the incidence of gastrointestinal bleeding. RESULTS: We enrolled 1,586 adult patients with pneumonia-induced sepsis. After PSM, 1,176 patients remained (588 in the heparin group and 588 in the non-heparin group). The 45-d survival rate was significantly higher in the heparin-treated group than that in the non-heparin group (84.4% vs. 79.4%; HR: 0.75; 95% CI: 0.572-0.83; adjusted HR: 0.73, 95% CI: 0.563-0.964; P < 0.05). LOS_ICU and LOS_Hospital were significantly shorter in the heparin group (P < 0.001), with no significant difference in gastrointestinal bleeding incidence between the two groups. Cox proportional hazards models demonstrated that heparin dose and duration were strongly associated with 45-d survival. Subgroup analysis indicated a significant survival advantage in patients aged 18-60 years, without diabetes, chronic obstructive pulmonary disease, or stage 1 acute kidney injury, who received a daily heparin dose of 3 mL for more than 7 d. CONCLUSION: Our study found that early administration of heparin, particularly in sufficient doses (Heparin Sodium 5,000 units/mL, 1 mL per dose, three times daily (TID)) for more than 7 d, was associated with reduced near-term mortality in critically ill patients with pneumonia-induced sepsis. These findings underscore the potential benefits of anticoagulant therapy in this high-risk patient population.

BACKGROUND: Anti-infective therapy against pathogens is the key to treatment of sepsis. Metagenomic next-generation sequencing (mNGS) has higher sensitivity than blood culture. The aim of this study was to use mNGS to identify DNAaemia of pathogens and to assess the diagnostic accuracy of presepsin (PSEP), procalcitonin (PCT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hsCRP) in differentiating between bacterial and nonbacterial infections in patients with sepsis. METHODS: This retrospective study included patients with sepsis from November 2020 to September 2022 in the Shenzhen Second People's Hospital. Blood samples were sent for blood culture and mNGS when the patients were diagnosed with sepsis. Plasma PSEP, PCT, and IL-6 levels were measured using whole blood specimens that were collected and analyzed after a diagnosis of sepsis. Area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy of PSEP, PCT, IL-6, and hsCRP for prediction of bacterial DNAaemia detected by mNGS in patients with sepsis. RESULTS: This study included 230 patients with sepsis. The bacterial DNAaemia rate was 53.0% [Gram-positive DNAaemia (GPD), Gram-negative DNAaemia (GND), and fungi DNAaemia rate was 18.2%, 37.8%, and 10.9%, respectively]. Among GND, CONCLUSIONS: Bacterial-DNAaemia was detected in half of the patients with sepsis. PSEP, PCT, IL-6, and hsCRP demonstrated significant predictive value for GND, PCT and IL-6 levels demonstrated significant predictive value for GPD. Meanwhile, only PCT demonstrated significant predictive value for fungal DNAaemia.