Sepsis-associated microbial metabolites as an indicator of complications during extracorporeal therapy in cases of sepsis and septic shock in children

Introduction

Modern blood purification technologies are widely used in intensive care to treat patients with sepsis and septic shock. Mortality was significant and increased as organ failure progressed; therefore, further evaluation of the effectiveness of extracorporeal therapy for severe sepsis and septic shock in children is necessary.

Aim

This study aimed to evaluate the change in the concentration of sepsis-associated microbial metabolites when using the method of extracorporeal therapy of severe sepsis and septic shock in children.

Materials and methods

The hemosorption was performed using a device for extracorporeal blood purification, Efferon LPS NEO (Efferon Company, Moscow, Russia), for children with sepsis and septic shock (n=30). The study protocol is available at Study Details | Lipopolysaccharide Adsorption (Efferon LPS NEO) in Children With Sepsis | ClinicalTrials.gov. The level of sepsis-associated microbial metabolites in the blood serum of children with sepsis or septic shock was measured using the method of gas chromatography–mass spectrometry.

Results

The concentration of phenyllactic acid before hemosorption was 0.8 (0.6; 1.3) µmol/l and after hemosorption, it was 0.6 (0.3; 1.2) µmol/l (p-value=0.034). The concentration of p-hydroxyphenylacetic acid before hemosorption was 1.1 (0.7; 2.7) µmol/l and after hemosorption, it was 0.8 (0.2; 1.2) µmol/l (p-value=0.023). The concentration of p-hydroxyphenyllactic acid before hemosorption was 2.8 (1.4; 4.6) µmol/l and after hemosorption, it was 0.8 (0.4; 3.7) µmol/l (p-value=0.041).

Conclusion

Blood metabolite analysis in sepsis has important clinical implications: Elevated and persistently elevated metabolite levels indicate irreversible changes in the body and an unfavorable prognosis. This emphasizes the central role of metabolic monitoring and the importance of microbial metabolism in both understanding and treating sepsis and septic shock in children.