Daily Sepsis Research Analysis

This PRISMA-ScR scoping review identified four heterogeneous studies involving 226 patients evaluating intrarenal antimicrobial or antiseptic irrigation during retrograde intrarenal surgery or percutaneous nephrolithotomy. All studies reported reductions in their respective infectious or microbiological endpoints, including lower fever, systemic inflammatory response syndrome, or sepsis rates, but differences in agents, procedures, timing, comparators, and outcomes prevented quantitative pooling.

Impact: The review addresses a practical and potentially modifiable source of post-endourological sepsis and highlights an intervention that could complement, rather than replace, systemic prophylaxis. Its balanced conclusion appropriately identifies the evidence as hypothesis-generating and prevents premature clinical adoption.

Clinical Implications: Intrarenal antimicrobial irrigation should not currently replace systemic antibiotic prophylaxis or standard infection-control measures. It may be considered an investigational adjunct in carefully selected settings, preferably within prospective trials with standardized dosing, intrarenal-pressure monitoring, microbiological outcomes, and adverse-event surveillance.

Future Directions: Adequately powered, multicenter, concurrently controlled trials should stratify patients by procedure and antimicrobial agent, standardize intrarenal pressure and dosing protocols, and evaluate clinically meaningful sepsis outcomes, antimicrobial resistance, and safety.

This systematic review identified eight studies of real-time artificial intelligence models using sequential or continuously updated hospital data for early sepsis prediction. Reported area under the receiver operating characteristic curve values were generally 0.83 to above 0.95, with some clinically meaningful lead times, but most studies had moderate risk of bias related to retrospective designs, heterogeneous sepsis definitions, and incomplete analytical reporting.

Impact: The review synthesizes a rapidly developing area that could enable earlier sepsis recognition while clearly separating predictive performance from demonstrated patient benefit. Its emphasis on calibration, external validation, false-alert mitigation, explainability, and workflow integration is directly relevant to safe clinical translation.

Clinical Implications: Real-time artificial intelligence models may support clinical surveillance and earlier assessment, but they should not replace clinician judgment or trigger treatment automatically without prospective validation. Implementation should include local recalibration, monitoring of alert burden and equity, transparent explanations, and evaluation of patient-centered outcomes.

Future Directions: Future studies should use prospective multicenter designs, standardized sepsis definitions, temporal and external validation, calibration assessment, subgroup fairness analyses, and pragmatic trials measuring treatment timeliness, alert burden, adverse events, and patient outcomes.

This retrospective single-center study evaluated serial heparin-binding protein measurements in 114 patients with sepsis, including 76 with sepsis-associated acute kidney injury and 38 without acute kidney injury. Heparin-binding protein was reported to have high early predictive value and superior diagnostic performance to procalcitonin and interleukin-6, although the available abstract data do not provide the exact area under the curve values.

Impact: Sepsis-associated acute kidney injury is common and clinically consequential, yet early recognition remains difficult. A biomarker that outperforms commonly used inflammatory markers could support earlier renal-risk stratification, but the single-center retrospective design means the finding is hypothesis-generating rather than practice-changing.

Clinical Implications: Heparin-binding protein may be useful as an adjunct to serial renal function assessment and established sepsis biomarkers in intensive care. It should not be used as a stand-alone diagnostic test until thresholds, timing, incremental value, and effects on clinical outcomes are validated across multiple centers and patient populations.

Future Directions: Prospective multicenter studies should establish clinically useful thresholds and sampling schedules, assess incremental value beyond SOFA score and standard biomarkers, and determine whether heparin-binding protein-guided management improves renal outcomes, mortality, or resource utilization.