17 th
OCTOBER 2013
Rapid blood test to diagnose sepsis at the bedside
could save thousands of lives, study suggests
Edited (by me) PLOSone Press release
Researchers
at King’s College London have identified a biomarker – a biological
‘fingerprint’ – for sepsis in the blood, and showed it could be possible to diagnose
the condition within two hours by screening for this biomarker at a patient’s
bedside. Sepsis (sometimes referred to as ‘blood poisoning’) is a
life-threatening condition that arises when the body’s inflammatory response to
a bacterial infection injures its own tissues and organs. Costing the NHS over
£2billion annually, the condition kills more people than breast and bowel
cancer combined (approximately 37,000 a year). Rapid diagnosis and treatment
with antibiotics saves lives, but as there are currently no biomarkers in
clinical use to enable fast diagnosis, it can take up to two days to analyse
samples in the laboratory.
Published
on the 16th October 2013 in the journal PLOS ONE and funded by both Guy’s and
St Thomas’ Charity and the National Institute for Health Research (NIHR)
Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and
King’s College London, this study highlights a possible biomarker for the rapid
diagnosis of sepsis. The work was performed in collaboration with Cepheid,
developer of the GeneXpert, which is capable of performing rapid molecular
detection.
Researchers
at King’s and Cepheid, a molecular diagnostics company, took samples of blood
from three groups of patients; those with sepsis, patients with other Systemic
Inflammatory Response Syndrome (that does not respond to antibiotics), and
healthy patients. From the blood samples they were able to amplify small
amounts of RNA into large quantities to see which particular microRNAs were
increased. By using this method, the team found that a certain group of
microRNAs were more active in the sepsis patients than in the other groups,
highlighting a potential biomarker for the condition.
The study
was replicated with a large group of Swedish patients with severe sepsis, which
validated the results. By using this method of screening and analysing the
blood in both studies, the researchers were able to diagnose sepsis within two
hours, with 86% accuracy.
Symptoms
of sepsis are similar to other types of Systemic Inflammatory Response Syndrome
(SIRS), yet only sepsis responds to antibiotics. It is therefore important for
clinicians to be able to distinguish sepsis from other types of SIRS as
administering antibiotics in non-sepsis cases can add pressure to the development
of antibiotic resistance. Professor Lord said: “Not only would an accurate
diagnostic test improve outcomes for patients, but it would contribute to
tackling the ongoing problem of antibiotic resistance by allowing clinicians to
distinguish between SIRS and sepsis and diagnose these severe conditions more
accurately.”
Plans for
a randomised clinical trial are underway at King’s College London and Guy’s and
St Thomas’ NHS Foundation Trust, part of King’s Health Partners Academic Health
Sciences Centre.
My Response and take on the Story
This work
is potentially quite exciting as the rapid diagnosis of fast moving diseases
such as sepsis is of great importance. In medicine, an early intervention in
these cases can often result in a much improved result for the patient. With
this in mind, any improvements or aids to the diagnosis of such diseases are to
be welcomed, especially when the tests are rapid and potentially able to be of
use at the point of care. The results reported in the paper are very
encouraging in that a reliable discrimination between sepsis and systemic
inflammatory response syndrome can be achieved, which in turn can help point
clinicians towards the most appropriate treatments to administer. Further
studies will be required to increase patient numbers sampled and so that the
full potential of this
test can
be realised.
Professor
Mark Fielder, Medical Microbiologist, Kingston University
London.
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