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Twenty percent of deaths worldwide are related to sepsis and it is the leading cause of death in the intensive care unit
We can only better treat sepsis if we better understand the patient’s immune system. Therefore, researchers should increasingly rely on artificial intelligence and omics techniques that can provide a more complete picture of the immune system. Researchers from Radboud University Hospital, among others, report this in a review article published in The Lancet Respiratory Medicine.
Twenty percent of all deaths worldwide are related to sepsis and it is the leading cause of death in the intensive care unit. Sepsis is caused by a combination of three factors: an infection, organ failure, such as the kidneys or lungs, and an impaired immune system response. This can cause patients to become so sick that they end up in the intensive care unit. About a third of patients die there.
There is still no good treatment for sepsis, says researcher Matthijs Kox. “We have antibiotics to fight the infection, but otherwise we only have supportive therapies.” Think, for example, of artificial ventilation if the lungs no longer function properly, or of kidney dialysis if there is kidney failure. But so far there is no drug that has been proven to be effective against sepsis.”
Kox and his colleagues focus their research on our immune system. Important, according to Kox, because we still understand too little about the dysregulated immune response. “Infection and organ failure can be diagnosed quite easily, but this does not apply to the status of the immune system. This is still largely a black box for us.”
Overreaction or paralysis
Two things can happen with sepsis: The immune system can work very hard, causing a violent overreaction that causes organs to fail. But it can also happen that the immune system is paralyzed and no longer does anything. Then the infection does not heal and further infections often occur, for example due to fungi, which do not bother healthy people at all. These infections are often difficult to treat.
How can we better map the status of the immune system? That’s the big question Kox and his colleagues are focusing on. He is trying to answer this question as part of the European partnership EGIS, which focuses on research into the immune system in sepsis. In a recent publication in The Lancet Respiratory Medicine, they discuss the value of various markers in the blood and call for more research using modern omics techniques. This allows a comprehensive picture of the immune system to be obtained with the help of artificial intelligence.
Not a single form of sepsis
The authors of the article argue that for too long sepsis has been viewed as a homogeneous syndrome where everyone is treated equally. Kox: “Fortunately, this idea is now outdated.” Sepsis comes in so many forms. You can get it from pneumonia, but also from a bladder infection or a simple wound on the foot. And the dysregulation of the immune system is a little different for everyone.” He draws the comparison with cancer: “Oncologists don’t treat all tumors the same.” You treat bladder cancer differently than breast cancer. And there are still big differences within these cancers. “That’s why the oncologists first determine the characteristics of the tumor and, based on this, initiate therapy.”
According to Kox, this is how things should work with sepsis. The aim of his research is to recognize more quickly and better what state the immune system is in: Is it working too hard or is it paralyzed and why is that? “If we can determine this quickly in an acute situation in the intensive care unit, doctors can help patients better.” We have medicine. “We just don’t know yet who we should give which medication to and when.”
Source: Radboud University Hospital
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