October 10, 2019
By Megan Brooks
NEW YORK (Reuters Health) - A blood test can identify a subgroup of pneumonia patients at increased risk for developing acute respiratory failure or sepsis, according to new research.
Pinpointing the host processes dysregulated in CAP patients, "especially in those who develop severe complications, could be crucial for future management of this disease," Dr. Francisco Sanz of the University of Valencia and colleagues write in a meeting abstract presented October 2 at the European Respiratory Society International Congress in Madrid.
To that end, they analyzed clinical data and used real-time PCR to determine microRNA profiles in blood samples from 169 hospitalized CAP patients (mean age, 66.9).
Of these, 109 (64.5%) developed complications. A quarter (25.4%) developed acute hypoxemic respiratory failure and 13.6% developed severe sepsis. The mortality rate was 3.6%.
The team found that three microRNAs known to be involved in lung and systemic inflammatory processes were helpful in predicting sepsis or respiratory failure.
Specifically, microRNA 223 was downregulated in severe sepsis (AUC, 0.78) and microRNA 574 was downregulated in respiratory failure (AUC, 0.77). In addition, microRNA 182 downregulation was highly predictive of both severe sepsis and acute respiratory failure (AUC, 0.83 and 0.76, respectively) in CAP patients.
"Our study has improved our understanding of the changes and processes that occur in the body in response to pneumonia by identifying these microRNAs that specifically determine complications, such as sepsis and respiratory failure," Dr. Sanz said in a conference statement.
"This has implications for prognosis. The potential use of these biomarkers would be at the time of admission of patients in order to anticipate the complications that they could develop. Once it was detected that the patient has a certain profile of microRNAs, more intensive support or monitoring measures could be implemented. The test is fast - it takes between one and three hours - and cheap, and it can be performed with techniques that are available in most hospitals," said Dr. Sanz.
Although the study was done in the hospital setting, it could be used in the outpatient setting as well, he noted. "In addition, due to the range of ages of the patients in our study, this could be applied to adult patients of all ages, although we cannot extrapolate the results to children," he said.
In email to Reuters Health, Dr. Sanz said, "Before its daily use in clinical practice, our work has to be published and an external validation of it would be very interesting for the confirmation of the results, so its practical application may take some time."
Commenting on the study in the statement, ERS President Dr. Tobias Welte of Hannover University, in Germany, said, "The innovative approach described in this study could provide a quick and cost-effective method for identifying patients at risk of developing sepsis or respiratory failure, which has the potential to save lives and improve patient quality of life, as well as reduce costs for health care providers. However, this test will have to be compared to guidelines and recommended best clinical practice to confirm its usefulness."
The study was funded by Sociedad Valenciana de Neumologia.
European Respiratory Society 2019.
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