Daily Sepsis Research Analysis

Sepsis-induced acute kidney injury (S-AKI) is a common and serious complication in critically ill children with a poor prognosis, and its early and accurate prediction remains challenging due to the lack of reliable biomarkers. Urinary small-molecule metabolomics offers a promising approach to capture the dynamic metabolic changes during the progression of S-AKI. In this two-center prospective observational study, we enrolled 360 children from both centers. Urine samples were collected within 24h after hospitalized children diagnosed with sepsis, stored at -80 °C, and analyzed using gas chromatography-mass spectrometry (GC-MS). Based on urinary metabolic fingerprints (U-MF), we developed and validated a machine learning model for early prediction of S-AKI. The Shapley Additive Explanations (SHAP) algorithm was applied to visually explain the optimal model. A panel of 10 metabolites was selected as common discriminative features. Among the 4 machine learning models evaluated, the support vector machine (SVM) demonstrated the best performance in both the discovery cohort (AUC 0.94, 95% CI: 0.91-0.98) and the external validation cohort (AUC 0.89, 95% CI: 0.82-0.96), enabling early prediction of S-AKI within 24 h. Furthermore, the U-MF panel was integrated into an open-access online platform to facilitate clinical translation. Our findings suggest that U-MF combined with machine learning holds promise as a robust and noninvasive approach with potential utility for early prediction of S-AKI in pediatric patients.

BACKGROUND: Serious bacterial infections (SBIs) are major contributors to neonatal morbidity and mortality in low-income countries. We describe the aetiology and risk factors for neonatal bacteraemia and in-hospital mortality in eastern Ethiopia, focusing on Pantoea dispersa, a rarely studied pathogen, and Klebsiella pneumoniae. METHODS: Prospective surveillance was conducted at Hiwot Fana Comprehensive Specialized Hospital (HFCSH), Harar, from December 2021 to November 2023. Blood for culture was drawn from neonates admitted with the WHO clinical definition of possible-SBI (pSBI). Isolates were identified using API kits and antimicrobial susceptibility tested by Kirby-Bauer method. FINDINGS: Among 1375 neonates with pSBI, blood was cultured from 1335 (97%), and 356 (27%) cultured pathogens. The commonest infections were Pantoea species (n = 145, 40.7%) and K. pneumoniae (n = 63, 17.7%); 128 Pantoea isolates were identified as P. dispersa by Matrix-Assisted Laser Desorption Ionization-Time of Flight. Case-fatality-ratios were 25% (32/128), 19% (9/47) and 19% (30/160) for P. dispersa, K. pneumoniae and other monomicrobial infections, respectively. P. dispersa showed resistance to ampicillin (99%) and cefotaxime (85%) but was otherwise broadly susceptible, while K. pneumoniae showed resistance to cefotaxime (100%) and gentamicin (89%), remaining susceptible only to amikacin and meropenem. Compared to non-bacteraemic admissions, P. dispersa bacteraemia was associated with health-facility delivery outside HFCSH (aOR 1.9 [95% CI, 1.21-2.97]), low birth weight (aOR 2.1 [95% CI,1.22-3.47]), and the dry season (aOR 9.7, [95% CI, 4.61-20.31]). K. pneumoniae bacteraemia was associated with health-facility delivery outside HFCSH (aOR, 2.2, [95% CI, 1.09-4.27]) alone. Among admissions with pSBI, death was associated with low birth weight and P. dispersa bacteraemia. INTERPRETATION: Bacteraemia was prevalent among neonates admitted with pSBI to HFCSH. P. dispersa and K. pneumoniae predominated and both had high mortality risks. Rigorous diagnostics and epidemiological associations support the interpretation of P. dispersa as a pathogen, necessitating local investigation into transmission and infection control interventions.

AIM: This meta-analysis aimed to assess syndecan-1 as a biomarker reflecting endothelial glycocalyx injury in sepsis, investigate its correlation with disease severity, organ complications and clinical prognosis, and clarifies its complementary value relative to conventional sepsis biomarkers. DESIGN: A systematic review and meta-analysis conducted in accordance with PRISMA guidelines. Data analysis was performed using Review Manager 5.3, with standardized mean differences (SMD) and 95% confidence intervals (CI) calculated. Subgroup analyses were stratified by sepsis definitions (Sepsis 1.0/2.0 vs. 3.0), and sensitivity analyses were performed by excluding studies with serious or critical ROBINS-I bias. PATIENTS: A total of 29 studies involving 4985 participants (3902 with sepsis) were included. MAIN OUTCOME MEASURES: Circulating syndecan-1 levels in sepsis patients versus non-sepsis controls, survivors versus non-survivors, and patients with septic shock, acute kidney injury (AKI) and disseminated intravascular coagulation (DIC). RESULTS: Syndecan-1 levels were significantly higher in sepsis patients than non-sepsis [SMD = 1.16, 95% CI (0.86, 1.47), p < 0.00001]. Non-survivors had significantly elevated levels compared with survivors, and higher levels were also observed in patients with septic shock, AKI and DIC (all p < 0.00001). Subgroup analyses yielded consistent findings across different sepsis definitions, and sensitivity analyses excluding 9 high-bias studies confirmed the robustness of the results. CONCLUSION: Elevated syndecan-1 indicates endothelial glycocalyx disruption in sepsis, and is closely linked to worse prognosis, septic shock and organ dysfunction. As a complementary biomarker to lactate, procalcitonin and C-reactive protein, it improves multi-domain sepsis risk stratification and supports individualized resuscitation and endothelial-protective intervention research.