Researchers at King's College London have identified a biomarker – a biological 'fingerprint' – for sepsis in the blood, and showed it could be possible to diagnose the condition within two hours by screening for this biomarker at a patient's bedside.
Sepsis (sometimes referred to as 'blood poisoning') is a life-threatening condition that arises when the body's inflammatory response to a bacterial infection injures its own tissues and organs. Costing the NHS over £2billion annually, the condition kills more people than breast and bowel cancer combined (approximately 37,000 a year). Rapid diagnosis and treatment with antibiotics saves lives, but as there are currently no biomarkers in clinical use to enable fast diagnosis, it can take up to two days to analyse samples in the laboratory.
Published today in the journal PLOS ONE and funded by both Guy's and St Thomas' Charity and the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, this study highlights a possible biomarker for the rapid diagnosis of sepsis. The work was performed in collaboration with Cepheid, developer of the GeneXpert, which is capable of performing rapid molecular detection.
RNA helps decode and regulate DNA. This paper investigated microRNAs, which come in many varieties and influence disease processes. Researchers at King's and Cepheid, a molecular diagnostics company, took samples of blood from three groups of patients; those with sepsis, patients with other Systemic Inflammatory Response Syndrome (that does not respond to antibiotics), and healthy patients. From the blood samples they were able to amplify small amounts of RNA into large quantities to see which particular microRNAs were increased. By using this method, the team found that a certain group of microRNAs were more active in the sepsis patients than in the other groups, highlighting a potential biomarker for the condition.
The study was replicated with a large group of Swedish patients with severe sepsis, which validated the results. By using this method of screening and analysing the blood in both studies, the researchers were able to diagnose sepsis within two hours, with 86 per cent accuracy.
Professor Graham Lord, Director of the NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, said: "Sepsis is a hidden killer, causing nearly a third of all hospital deaths. Rapid antibiotic treatment for the condition is vital – every minute counts. Yet current diagnostic methods can take up to two days, so an accurate diagnostic test that can be carried out at the patient's bedside is urgently needed.
"We have for the first time identified a group of biomarkers in the blood that are good indicators of sepsis. We have shown that it is possible to detect these markers by screening a patient's blood in the ward, a process which can deliver results within two hours. This is an extremely exciting development which has the potential to completely transform the management of this severe disease and save thousands of lives worldwide every year. These are promising early findings, and now we need to test this approach in a large clinical trial."
Symptoms of sepsis are similar to other types of Systemic Inflammatory Response Syndrome (SIRS), yet only sepsis responds to antibiotics. It is therefore important for clinicians to be able to distinguish sepsis from other types of SIRS as administering antibiotics in non-sepsis cases can add pressure to the development of antibiotic resistance. Professor Lord continued: "Not only would an accurate diagnostic test improve outcomes for patients, but it would contribute to tackling the ongoing problem of antibiotic resistance by allowing clinicians to distinguish between SIRS and sepsis and diagnose these severe conditions more accurately."
Plans for a randomised clinical trial are underway at King's College London and Guy's and St Thomas' NHS Foundation Trust, part of King's Health Partners Academic Health Sciences Centre.
Notes to editors:
For further information or a copy of the paper please contact Katherine Barnes
King's College London
King's College London is one of the top 20 universities in the world (2013/14 QS World University Rankings), and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 25,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and some 6,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate. King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: http://www.kingshealthpartners.org.
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website.
Journal
PLoS ONE