多中心INTELLIGENCE试验中白细胞的血液生物标志物和拉曼分析:在重症监护室(INTELLIGENCE-1)和急诊科(INTELLIGENCE-2)。

IF 2.9 3区 医学 Q2 CRITICAL CARE MEDICINE
SHOCK Pub Date : 2025-09-25 DOI:10.1097/SHK.0000000000002699
Evangelos J Giamarellos-Bourboulis, Daniel Thomas-Rüddel, Aikaterini Pistiki, Anuradha Ramoji, Oleg Ryabchykov, Kazi Sultana Farhana Azam, Konstantinos Toutouzas, Athanasios Prekates, Stylianos Karatzas, Christos Mathas, Antigone Kotsaki, Stamatios Chalvatzis, Nikolaos Antonakos, Georgia Damoraki, Jan Rüger, Florian Knorr, Natalie Arend, Anja Silge, Iwan Schie, Jesper Eugen-Olsen, Thomas Bocklitz, Michael Bauer, Johannes Winning, Michael Kiehntopf, Jürgen Popp, Frank Bloos, Ute Neugebauer
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引用次数: 0

摘要

背景:败血症被定义为由宿主对感染反应失调引起的危及生命的器官功能障碍,伴随着一种复杂且尚未完全了解的宿主反应。尽管有许多不同的生物标志物,但仍然需要最佳的筛选工具来识别脓毒症患者。在之前的一项单中心临床试验中,明确且分离良好的患者队列,一种基于白细胞拉曼光谱特征的新的生物光子标记物显示出对患者分层和识别感染和败血症的附加价值。结果:在INTELLIGENCE研究中,分析了来自两个国家六个中心的279例患者,并在仅1小时内测量了每位患者约1500个白细胞的拉曼光谱。这标志着拉曼光谱在多中心临床试验中的可用性和技术准备水平从实验室到床边迈出了一大步。白细胞拉曼评分的鉴别能力与单个常规生物标志物(CRP、PCT、IL-6、suPAR)相当,但在INTELLIGENCE-1研究的重症感染患者队列中,白细胞拉曼评分不能为脓毒症的临床鉴别提供附加价值。当将INTELLIGENCE-1的分类模型翻译为在急诊科招募的双盲INTELLIGENCE-2试验的异质患者队列时,Raman评分未能提供附加价值。结论:理论上,白细胞拉曼评估可能仍然是脓毒症诊断和患者分层的一种有前景的工具,但需要更多的基础、转化和临床研究来完善其可用性和临床作用,可能还需要考虑到表型分层中失调宿主反应的病理生理学问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Blood biomarker and Raman analysis of leukocytes in the multicenter INTELLIGENCE trials: at the Intensive Care Unit (INTELLIGENCE-1) and the Emergency Department (INTELLIGENCE-2).

Background: Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, goes along with a complex and not yet fully understood host response. Despite many different biomarkers, optimal screening tools to identify patients with sepsis are still needed. In a previous, single-center clinical trial with well-defined and well-separated patient cohorts, a new biophotonic marker based on the Raman spectroscopic characterization of leukocytes showed added value to stratify patients and identify infection and sepsis.

Results: In the INTELLIGENCE studies, 279 patients from six centres in two countries were analysed and the Raman spectra of ~1500 leukocytes per patient measured within only 1 hour. This marks a huge step from bench to bedside regarding usability and technology readiness level of Raman spectroscopy in multicentre clinical trials. With a discriminatory power comparable to individual conventional biomarkers (CRP, PCT, IL-6, suPAR), the Raman score of leukocytes could not provide added value to the clinical discrimination of sepsis in the INTELLIGENCE-1 study cohorts of intensive care patients with infections. When translating the classification model from INTELLIGENCE-1 to the heterogeneous patient cohort recruited at the emergency department of the double-blinded INTELLIGENCE-2 trial, the Raman score failed to provide added value.

Conclusions: In theory, Raman assessment of leukocytes might still be a promising tool for sepsis diagnosis and patient stratification, but there is more basic, translational and clinical research needed to refine its usability and clinical role, probably also taking questions of the pathophysiology of the dysregulated host response for a phenotype stratification into account.

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来源期刊
SHOCK
SHOCK 医学-外科
CiteScore
6.20
自引率
3.20%
发文量
199
审稿时长
1 months
期刊介绍: SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.
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