title: Metabolites in Blood for Prediction of Bacteremic Sepsis in the Emergency Room.
abstract: A metabolomics approach for prediction of bacteremic sepsis in patients in the emergency room (ER) was investigated. In a prospective study, whole blood samples from 65 patients with bacteremic sepsis and 49 ER controls were compared. The blood samples were analyzed using gas chromatography coupled to time-of-flight mass spectrometry. Multivariate and logistic regression modeling using metabolites identified by chromatography or using conventional laboratory parameters and clinical scores of infection were employed. A predictive model of bacteremic sepsis with 107 metabolites was developed and validated. The number of metabolites was reduced stepwise until identifying a set of 6 predictive metabolites. A 6-metabolite predictive logistic regression model showed a sensitivity of 0.91(95% CI 0.69-0.99) and a specificity 0.84 (95% CI 0.58-0.94) with an AUC of 0.93 (95% CI 0.89-1.01). Myristic acid was the single most predictive metabolite, with a sensitivity of 1.00 (95% CI 0.85-1.00) and specificity of 0.95 (95% CI 0.74-0.99), and performed better than various combinations of conventional laboratory and clinical parameters. We found that a metabolomics approach for analysis of acute blood samples was useful for identification of patients with bacteremic sepsis. Metabolomics should be further evaluated as a new tool for infection diagnostics.
authors.affiliation: Department of Clinical Microbiology, Clinical Bacteriology, the Laboratory for Molecular Infection Medicine Sweden and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Kauppi
authors.affiliation: Department of Clinical Microbiology, Clinical Bacteriology, the Laboratory for Molecular Infection Medicine Sweden and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.
authors.forename: Alicia
authors.initials: A
authors.lastname: Edin
authors.affiliation: Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ziegler
authors.affiliation: Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Paula
authors.initials: P
authors.lastname: Mölling
authors.affiliation: Department of Clinical Microbiology, Clinical Bacteriology, the Laboratory for Molecular Infection Medicine Sweden and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Sjöstedt
authors.affiliation: Department of Clinical Microbiology, Clinical Bacteriology, the Laboratory for Molecular Infection Medicine Sweden and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Gylfe
authors.affiliation: Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Strålin
authors.affiliation: Department of Clinical Microbiology, Clinical Bacteriology, the Laboratory for Molecular Infection Medicine Sweden and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Johansson
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D004187:Disaccharides; D004636:Emergency Service, Hospital; D005260:Female; D005965:Glucuronates; D006801:Humans; D008297:Male; D055432:Metabolomics; D019814:Myristic Acid / Q000097:blood; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D004187:Disaccharides; D005965:Glucuronates; D019814:Myristic Acid; C059554:O-(glucuronic acid 2-sulfate)-(1--4)-O-(2,5)-anhydromannitol 6-sulfate