Getting a step ahead of sepsis

Written by Matthew J. Baker, Guest Web-writer for Analyst and Senior Lecturer in Toxicology and Analytical Chemistry at the University of Central Lancashire (UCLan), UK.

Early detection of sepsis followed by immediate intervention is essential in the fight against sepsis. Researchers from the University of Wisconsin – Madison have recently described a technique for the analysis of exhaled breath carbon isotope delta values as a noninvasive diagnostic test in this fight.

Systemic inflammatory response syndrome (SIRS) is a nonspecific response following events such as infection, trauma or surgery. SIRS is a major problem in the care of intensive care patients and has been reported to occur in 82 % of pediatric intensive care patients including the 23 % of patients admitted with sepsis. Sepsis is SIRS in the presence of an infection and is the most common cause of death in infants and children in the world. The US researchers showed a measurable difference between the exhaled breath carbon isotope delta values (BDVs i.e. 13CO2/12CO2 delta value) and the inflammatory acute phase response (APR) state of a pediatric patient. Whether the patient has no infection, trauma or surgery, the patient has trauma or post-operative status, active sepsis or shock.

Schematic representation of fractionation of carbon during the catabolic inflammatory acute phase response to infection

Prof. Butz, University of Wisconsin-Madison highlights that “it has long been known that Carbon-13 behaves differently due to enzymatic fractionation. With the emergence of new carbon isotope sensing devices, such as cavity-ring down spectroscopy, measurement of the stable isotopes of carbon is much cheaper and more portable than has previously been possible.”

In addition to discriminating patients for inflammatory APR state, the authors also suggest that the BDV could be used to monitor the changes in physiology during sepsis and septic shock due to changes in macronutrient oxidation. This opens up a bright future for BDVs in the clinic with “The potential for breath based measurements, such as the breath carbon delta value or BDV, making the intriguing case that noninvasive breath sampling can inform doctors and scientists about changes in the body’s metabolism. New instruments are being developed into medical devices that can be placed in the intensive care unit, emergency department, hospital ward, or clinic, and may be used by doctors to make determination about a patients nutritional, metabolic, or health status” adds Butz.

You can download the full article below, which is free to access until March 11th.

Changes in breath carbon isotope composition as a potential biomarker of inflammatory acute phase response in mechanically ventilated pediatric patients
Juan P. Boriosi, Dennis G. Maki, Rhonda A. Yngsdal-Krenz, Ellen R. Wald, Warren P. Porter, Mark E. Cook and Daniel E. Bütz 
J. Anal. At. Spectrom., 2014, Advance Article
DOI: 10.1039/C3JA50331C

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