Intestinal Barrier Dysfunction, Bacterial Translocation and Inflammation: Deathly Triad in Sepsis

Sepsis, as a complex entity, comprises multiple pathophysiological mechanisms which bring about high morbidity and mortality. The previous studies showed that the gastrointestinal tract is damaged during sepsis, and its main symptoms include increased permeability, bacterial translocation (BT), and malabsorption. BT is the invasion of indigenous intestinal bacteria via the gut mucosa to other tissues. It occurs in pathological conditions such as disruption of the intestine’s ecological balance and mucosal barrier permeability, immunosuppression, and oxidative stress through transcellular/paracellular pathways and initiate an excessive systemic inflammatory response. Thereby, recent clinical and preclinical studies focus on the association between sepsis and intestinal barrier dysfunction. This chapter overviews the current knowledge about the molecular basis of BT of the intestine, its role in the progress of sepsis, detection of BT, and actual therapeutic approaches.

Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department: comparison with CRP and procalcitonin in a multicenter international European prospective study

Background Early sepsis diagnosis has emerged as one of the main challenges in the emergency room. Measurement of sepsis biomarkers is largely used in current practice to improve the diagnosis accuracy. Monocyte distribution width (MDW) is a recent new sepsis biomarker, available as part of the complete blood count with differential. The objective was to evaluate the performance of MDW for the detection of sepsis in the emergency department (ED) and to compare to procalcitonin (PCT) and C-reactive protein (CRP). Methods Subjects whose initial evaluation included a complete blood count were enrolled consecutively in 2 EDs in France and Spain and categorized per Sepsis-2 and Sepsis-3 criteria. The performance of MDW for sepsis detection was compared to that of procalcitonin (PCT) and C-reactive protein (CRP). Results A total of 1,517 patients were analyzed: 837 men and 680 women, mean age 61 ± 19 years, 260 (17.1%) categorized as Sepsis-2 and 144 patients (9.5%) as Sepsis-3. The AUCs [95% confidence interval] for the diagnosis of Sepsis-2 were 0.81 [0.78–0.84] and 0.86 [0.84–0.88] for MDW and MDW combined with WBC, respectively. For Sepsis-3, MDW performance was 0.82 [0.79–0.85]. The performance of MDW combined with WBC for Sepsis-2 in a subgroup of patients with low sepsis pretest probability was 0.90 [0.84–0.95]. The AUC for sepsis detection using MDW combined with WBC was similar to CRP alone (0.85 [0.83–0.87]) and exceeded that of PCT. Combining the biomarkers did not improve the AUC. Compared to normal MDW, abnormal MDW increased the odds of Sepsis-2 by factor of 5.5 [4.2–7.1, 95% CI] and Sepsis-3 by 7.6 [5.1–11.3, 95% CI]. Conclusions MDW in combination with WBC has the diagnostic accuracy to detect sepsis, particularly when assessed in patients with lower pretest sepsis probability. We suggest the use of MDW as a systematic screening test, used together with qSOFA score to improve the accuracy of sepsis diagnosis in the emergency department. Trial Registration ClinicalTrials.gov (NCT03588325).

MGP-AttTCN: An interpretable machine learning model for the prediction of sepsis

With a mortality rate of 5.4 million lives worldwide every year and a healthcare cost of more than 16 billion dollars in the USA alone, sepsis is one of the leading causes of hospital mortality and an increasing concern in the ageing western world. Recently, medical and technological advances have helped re-define the illness criteria of this disease, which is otherwise poorly understood by the medical society. Together with the rise of widely accessible Electronic Health Records, the advances in data mining and complex nonlinear algorithms are a promising avenue for the early detection of sepsis. This work contributes to the research effort in the field of automated sepsis detection with an open-access labelling of the medical MIMIC-III data set. Moreover, we propose MGP-AttTCN: a joint multitask Gaussian Process and attention-based deep learning model to early predict the occurrence of sepsis in an interpretable manner. We show that our model outperforms the current state-of-the-art and present evidence that different labelling heuristics lead to discrepancies in task difficulty. For instance, when predicting sepsis five hours prior to onset on our new realistic labels, our proposed model achieves an area under the ROC curve of 0.660 and an area under the PR curve of 0.483, whereas the (less interpretable) previous state-of-the-art model (MGP-TCN) achieves 0.635 AUROC and 0.460 AUPR and the popular commercial InSight model achieves 0.490 AUROC and 0.359 AUPR.

Longitudinal Zeolite-Iron Oxide Nanocomposite Deposited Capacitance Biosensor for Interleukin-3 in Sepsis Detection

Sepsis is an extreme condition involving a physical response to severe microbial infection and causes fatal and life-threatening issues. Sepsis generates during the chemicals release with the immune system into the bloodstream for fighting against an infection, which causes the inflammation and leads to the medical emergency. A complexed longitudinal zeolite and iron oxide nanocomposite was extracted from coal mine fly ash and utilized to improve the surface characteristics of the capacitance biosensor to identify sepsis attacks. Anti-interleukin-3 (anti-IL-3) antibody was attached to the zeolite- and iron oxide-complexed capacitance electrode surface through an amine linker to interact with the sepsis biomarker IL-3. The morphological and chemical components of the nanocomplex were investigated by FESEM, FETEM, and EDX analyses. At approximately 30 nm, the longitudinal zeolite and iron oxide nanocomposite aided in attaining the limit of IL-3 detection of 3 pg/mL on the linear curve, with a regression coefficient (R2) of 0.9673 [y = 1.638x − 1.1847]. A lower detection limit was achieved in the dose-dependent range (3–100 pg/mL) due to the higher amount of antibody immobilization on the sensing surface due to the nanomaterials and the improved surface current. Furthermore, control experiments with relevant biomolecules did not show capacitance changes, and spiked IL-3 in human serum increased capacitance, indicating the specific and selective detection of IL-3. This study identifies and quantifies IL-3 via potentially useful methods and helps in diagnosing sepsis attack.

Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units

Objectives Patients in Intensive Care Units (ICU) are a high-risk population for sepsis, recognized as a major cause of admission and death. The aim of the current study was to evaluate the diagnostic accuracy and prognostication of monocyte distribution width (MDW) in sepsis for patients admitted to ICU. Methods Between January and June 2020, we conducted a prospective observational study during the hospitalization of 506 adult patients admitted to the ICU. MDW was evaluated in 2,367 consecutive samples received for routine complete blood counts (CBC) performed once a day and every day during the study. Sepsis was diagnosed according to Sepsis-3 criteria and patients enrolled were classified in the following groups: no sepsis, sepsis and septic shock. Results MDW values were significantly higher in patients with sepsis or septic shock in comparison to those within the no sepsis group [median 26.23 (IQR: 23.48–29.83); 28.97 (IQR: 21.27–37.21); 21.99 (IQR: 19.86–24.36) respectively]. ROC analysis demonstrated that AUC is 0.785 with a sensitivity of 66.88% and specificity of 77.79% at a cut-off point of 24.63. In patients that developed an ICU-acquired sepsis MDW showed an increase from 21.33 [median (IQR: 19.47–21.72)] to 29.19 [median (IQR: 27.46–31.47)]. MDW increase is not affected by the aetiology of sepsis, even in patients with COVID-19. In sepsis survivors a decrease of MDW values were found from the first time to the end of their stay [median from 29.14 (IQR: 26.22–32.52) to 25.67 (IQR: 22.93–30.28)]. Conclusions In ICU, MDW enhances the sepsis detection and is related to disease severity.