Sepsis is a complex condition characterized by the simultaneous activation of inflammation and coagulation in response to microbial insult or infection(1). Unfortunately, it’s a heck of a lot easier to define sepsis than it is to diagnose or treat the disease. In fact, there is no one fast, efficient test that can definitively say if a patient does or does not have sepsis. Instead, physicians rely on a combination of strategies to diagnose sepsis, including a patient’s medical history and current symptoms as well as diagnostic testing(2). It takes a lot of time to collect all this data – time that might cost a life, since sepsis is much more treatable in its earliest stage.
Ready to Rock
While no one test can categorically diagnose sepsis, simultaneously spotlight the right treatment, and do it all immediately, there is progress to report.
In 2017, the U.S. Food and Drug Association (FDA) approved a blood test, Accelerate PhenoTest BC kit (Accelerate Diagnostic)(3), that may provide a rapid and specific sepsis diagnosis while also delivering information about treatment options for early-stage sepsis. More specifically, the test can identify the genus and species of common Gram-positive and Gram-negative bacterial infections that can lead to sepsis, show their sensitivity or resistance to several antibiotics, and identify sepsis caused by Candida fungal species. Wait. There’s more! A physician gets this data nearly 42 hours quicker than with current tests.
Also accomplished in 2017, University of Illinois’ researchers and physicians at Carle Foundation Hospital developed a rapid test for sepsis(4), which counts white blood cells and certain protein markers on the cells’ surface to monitor a patient’s immune response. It is the first test to provide rapid, point-of-care measurement of the immune system’s response – without needing to process the blood – and thus helping doctors identify sepsis at the onset. This hugely elevates a physician’s ability to monitor the infection and with further development, may someday point to a prognosis.
On the Horizon
A team from the Columbia University(5) Irving Medical Center noted that the immune system initially launches a vigorous attack against sepsis – but then the innate immune response shuts down. After analyzing the underlying mechanism, the team identified two specific molecules – microRNAs (miR-221 and miR-222) – that were produced in immune cells during prolonged inflammation. Researchers are now studying these two microRNAs as the basis for a test that could help clinicians classify patients into one or two categories:
- Those with organ failure and at high risk of sepsis and death
- Those with milder infections
Future clinical trials will validate the usefulness of testing patients for microRNAs as a quick guide to sepsis prognosis and treatment.
A second study(6) hypothesizes that the extracellular plasma MV-A iNOS in circulating micro vesicles is centrally involved in the initiation of sepsis – and a diagnostic test based on plasma iNOS may serve as an early presymptomatic warning signal for the onset of sepsis. A novel panel of plasma biomarkers is proposed as a multianalyte presymptomatic method to stage the onset of sepsis for improved, prompt, data-driven patient care.
Front-line physicians and healthcare teams are not only watching the development of tests to diagnose sepsis; they’re also hotly monitoring information concerning when to test. Currently testing is typically initiated after the patient is already sick and/or in the hospital, which makes it difficult to get ahead of the disease. That said, every bit of news is welcome when it comes to testing, diagnosing, and treating patients with sepsis.
To review last week’s feature on sepsis basics, check out A Close Look At Sepsis – Part 1
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Resources
1) Sepsis and Septic Shock: Current Treatment Strategies and New Approaches
2) Testing for Sepsis – Sepsis Alliance
3) Sepsis (Septicemia) Diagnosis, Causes, Treatment & Symptoms
4) Quick test finds signs of sepsis in a single drop of blood
5) Immune system research offers hope of speedier sepsis diagnosis
6) Inducible Nitric Oxide Synthase in Circulating Microvesicles
