Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept study
BackgroundTranscriptomics biomarkers have been widely used to predict mortality in patients with sepsis. However, the association between mRNA levels and outcomes shows substantial variability over the course of sepsis, limiting their predictive performance. We aimed to: (a) identify and validate an...
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Frontiers Media S.A.
2025-01-01
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| author | Marie-Angélique Cazalis Marie-Angélique Cazalis Louis Kreitmann Louis Kreitmann Guillaume Monneret Guillaume Monneret Alexandre Pachot Alexandre Pachot Karen Brengel-Pesce Karen Brengel-Pesce Jean-François Llitjos Jean-François Llitjos Jean-François Llitjos |
| author_facet | Marie-Angélique Cazalis Marie-Angélique Cazalis Louis Kreitmann Louis Kreitmann Guillaume Monneret Guillaume Monneret Alexandre Pachot Alexandre Pachot Karen Brengel-Pesce Karen Brengel-Pesce Jean-François Llitjos Jean-François Llitjos Jean-François Llitjos |
| author_sort | Marie-Angélique Cazalis |
| collection | DOAJ |
| description | BackgroundTranscriptomics biomarkers have been widely used to predict mortality in patients with sepsis. However, the association between mRNA levels and outcomes shows substantial variability over the course of sepsis, limiting their predictive performance. We aimed to: (a) identify and validate an mRNA biomarker signature whose association with all-cause intensive care unit (ICU) mortality is consistent at several timepoints; and (b) evaluate how this mRNA signature could be used in association with lactate levels for predictive and prognostic enrichment in sepsis.MethodsWe conducted a gene expression analysis study at two timepoints (day 1 and day 2–3 following ICU admission) using microarray data from adult septic patients to identify candidate biomarkers predictive of all-cause ICU mortality. We validated mRNA biomarkers using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) on an external validation cohort. The predictive performance of the mRNA biomarkers combination was assessed in association with lactate level to refine ICU mortality prediction.Main resultsAmong 180 chips from 100 septic patients, we identified 39 upregulated and 2 downregulated differentially expressed genes (DEGs) in survivors vs. non-survivors, both at day 1 and days 2–3 following ICU admission. We combined CDK1, the hub gene of upregulated DEGs, and CX3CR1 and IL1b to compute expression ratios. The CDK1/CX3CR1 ratio had the best performance to predict all-cause ICU mortality, with an area under the ROC curve (AUROC) of 0.77 (95% confidence interval [CI] 0.88–0.66) at day 1 and of 0.82 (95% CI 0.91–0.72) at days 2–3 after ICU admission. This performance was better than that of each individual mRNA biomarker. In the external validation cohort, the predictive performance of the CDK1/CX3CR1 ratio, measured using RT-qPCR, was similar to that of lactate when measure at day 1, and higher when measured at days 2–3. Combining lactate levels and the CDK1/CX3CR1 ratio, we identify 3 groups of patients with an increasing risk of ICU-mortality, ranging from 9 to 60% with an intermediate-risk group mortality rate of 28%.ConclusionWith stable predictive performance over the first 3 days following ICU admission, the CDK1/CX3CR1 ratio identifies three groups of septic patients with increasing ICU mortality risk. In combination with lactate, this novel biomarker strategy may be useful for sepsis patient stratification for personalized medicine trials and ICU management. |
| format | Article |
| id | doaj-art-7d4570c76acb404797900f3cda45a60d |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj-art-7d4570c76acb404797900f3cda45a60d2025-01-03T06:47:26ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-01-011110.3389/fmed.2024.14454511445451Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept studyMarie-Angélique Cazalis0Marie-Angélique Cazalis1Louis Kreitmann2Louis Kreitmann3Guillaume Monneret4Guillaume Monneret5Alexandre Pachot6Alexandre Pachot7Karen Brengel-Pesce8Karen Brengel-Pesce9Jean-François Llitjos10Jean-François Llitjos11Jean-François Llitjos12Joint Research Unit HCL-bioMérieux, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon, bioMérieux), Lyon, FranceOpen Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy l’Etoile, FranceJoint Research Unit HCL-bioMérieux, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon, bioMérieux), Lyon, FranceOpen Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy l’Etoile, FranceJoint Research Unit HCL-bioMérieux, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon, bioMérieux), Lyon, FranceImmunology Laboratory, Edouard Herriot Hospital – Hospices Civils de Lyon, Lyon, FranceJoint Research Unit HCL-bioMérieux, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon, bioMérieux), Lyon, FranceOpen Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy l’Etoile, FranceJoint Research Unit HCL-bioMérieux, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon, bioMérieux), Lyon, FranceOpen Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy l’Etoile, FranceJoint Research Unit HCL-bioMérieux, EA 7426 “Pathophysiology of Injury-Induced Immunosuppression” (Université Claude Bernard Lyon 1 – Hospices Civils de Lyon, bioMérieux), Lyon, FranceOpen Innovation and Partnerships (OI&P), bioMérieux S.A., Marcy l’Etoile, FranceDepartment of Anaesthesia and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, FranceBackgroundTranscriptomics biomarkers have been widely used to predict mortality in patients with sepsis. However, the association between mRNA levels and outcomes shows substantial variability over the course of sepsis, limiting their predictive performance. We aimed to: (a) identify and validate an mRNA biomarker signature whose association with all-cause intensive care unit (ICU) mortality is consistent at several timepoints; and (b) evaluate how this mRNA signature could be used in association with lactate levels for predictive and prognostic enrichment in sepsis.MethodsWe conducted a gene expression analysis study at two timepoints (day 1 and day 2–3 following ICU admission) using microarray data from adult septic patients to identify candidate biomarkers predictive of all-cause ICU mortality. We validated mRNA biomarkers using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) on an external validation cohort. The predictive performance of the mRNA biomarkers combination was assessed in association with lactate level to refine ICU mortality prediction.Main resultsAmong 180 chips from 100 septic patients, we identified 39 upregulated and 2 downregulated differentially expressed genes (DEGs) in survivors vs. non-survivors, both at day 1 and days 2–3 following ICU admission. We combined CDK1, the hub gene of upregulated DEGs, and CX3CR1 and IL1b to compute expression ratios. The CDK1/CX3CR1 ratio had the best performance to predict all-cause ICU mortality, with an area under the ROC curve (AUROC) of 0.77 (95% confidence interval [CI] 0.88–0.66) at day 1 and of 0.82 (95% CI 0.91–0.72) at days 2–3 after ICU admission. This performance was better than that of each individual mRNA biomarker. In the external validation cohort, the predictive performance of the CDK1/CX3CR1 ratio, measured using RT-qPCR, was similar to that of lactate when measure at day 1, and higher when measured at days 2–3. Combining lactate levels and the CDK1/CX3CR1 ratio, we identify 3 groups of patients with an increasing risk of ICU-mortality, ranging from 9 to 60% with an intermediate-risk group mortality rate of 28%.ConclusionWith stable predictive performance over the first 3 days following ICU admission, the CDK1/CX3CR1 ratio identifies three groups of septic patients with increasing ICU mortality risk. In combination with lactate, this novel biomarker strategy may be useful for sepsis patient stratification for personalized medicine trials and ICU management.https://www.frontiersin.org/articles/10.3389/fmed.2024.1445451/fullsepsislactateintensive care unitCdk1CX3CR1biomarkers |
| spellingShingle | Marie-Angélique Cazalis Marie-Angélique Cazalis Louis Kreitmann Louis Kreitmann Guillaume Monneret Guillaume Monneret Alexandre Pachot Alexandre Pachot Karen Brengel-Pesce Karen Brengel-Pesce Jean-François Llitjos Jean-François Llitjos Jean-François Llitjos Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept study Frontiers in Medicine sepsis lactate intensive care unit Cdk1 CX3CR1 biomarkers |
| title | Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept study |
| title_full | Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept study |
| title_fullStr | Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept study |
| title_full_unstemmed | Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept study |
| title_short | Whole blood ratio of CDK1/CX3CR1 mRNA expression combined to lactate refines the prediction of ICU mortality in septic patients in the Sepsis-3 era: a proof-of-concept study |
| title_sort | whole blood ratio of cdk1 cx3cr1 mrna expression combined to lactate refines the prediction of icu mortality in septic patients in the sepsis 3 era a proof of concept study |
| topic | sepsis lactate intensive care unit Cdk1 CX3CR1 biomarkers |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1445451/full |
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