title: Serum procalcitonin levels in combination with (1)H NMR spectroscopy: A rapid indicator for differentiation of urosepsis.
abstract: BACKGROUND
  Urosepsis, a severe form of sepsis requires immediate medical attention for prognosis. It is clinically diagnosed by estimating serum procalcitonin (PCT) levels along with time taking urine and blood cultures. We explored NMR based profiling, deriving metabolites that could potentially aid diagnosis.
  
  
  METHODS
  The proton NMR of serum and urine samples of healthy control subjects (n=32) and urosepsis cases (n=35) based on PCT levels, were analyzed. Four clinically identified non-urosepsis cases with high PCT levels were also differentiated through principal component analysis (PCA) of the serum samples.
  
  
  RESULTS
  Quantification of serum and urine through Discriminant Function Analysis (DFA) afforded 93.7% and 91.7% correct classification respectively, along with identification of malonate and urea as potential biomarkers for the disease in both urine and serum samples. The partial least square discriminant analysis (PLS-DA) showed an R(2) value of 0.97 in both biofluids with Q(2)=0.87 and 0.85 for serum and urine respectively. The training set of serum samples provided precise prediction of the test set in a small cohort through random re-sampling method, while in urine samples, the predictions were inconclusive.
  
  
  CONCLUSIONS
  Our pilot study reveals that (1)H NMR of serum metabolic profiling in combination with PCT levels may provide a rapid method for differentiation of urosepsis.
authors.affiliation: Centre of Biomedical Research, formerly known as Centre of Biomedical Magnetic Resonance, SGPGIMS Campus, Raibarely Road, Lucknow 226014, Uttar Pradesh, India.
authors.forename: Suruchi
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow 226010, Uttar Pradesh, India.
authors.forename: Tanushri
authors.initials: T
authors.lastname: Chatterji
authors.affiliation: Department of Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow 226010, Uttar Pradesh, India. Electronic address: sen_manodeep6@yahoo.com.
authors.forename: Manodeep
authors.initials: M
authors.lastname: Sen
authors.affiliation: Department of Urology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow 226010, Uttar Pradesh, India.
authors.forename: Ishwar Ram
authors.initials: IR
authors.lastname: Dhayal
authors.affiliation: Department of Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow 226010, Uttar Pradesh, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Vibhuti Khand, Gomti Nagar, Lucknow 226010, Uttar Pradesh, India.
authors.forename: Nuzhat
authors.initials: N
authors.lastname: Husain
authors.affiliation: Department of Urology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India.
authors.forename: Apul
authors.initials: A
authors.lastname: Goel
authors.affiliation: Centre of Biomedical Research, formerly known as Centre of Biomedical Magnetic Resonance, SGPGIMS Campus, Raibarely Road, Lucknow 226014, Uttar Pradesh, India. Electronic address: roy@cbmr.res.in.
authors.forename: Raja
authors.initials: R
authors.lastname: Roy
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000652:urine; D002116:Calcitonin / Q000097:blood* / Q000652:urine; D015740:Calcitonin Gene-Related Peptide; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D010865:Pilot Projects; D011498:Protein Precursors / Q000097:blood* / Q000652:urine; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology* / Q000652:urine; D013997:Time Factors; D014552:Urinary Tract Infections / Q000150:complications*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Metabolic profiling; Multivariate statistical analysis; Septicemia; Serum procalcitonin levels; UTI; Urosepsis