Dados do Trabalho

Título

Prognostic evaluation of genomic endotypes in sepsis: a Brazilian cohort study using real-time polymerase chain reaction

Objetivo

To investigate the prognostic potential of MARS 1 endotype in a Brazilian cohort with sepsis and to evaluate the possible associations of MARS 1, 2, 3, and 4 with different clinical phenotypes and mortality.

Métodos

A prospective observational study was conducted in intensive care units of Curitiba, Brazil, and enrolled participants in their first 24 hours of the diagnosis of sepsis. The inclusion criteria were age ≥ 18 years and absence of any prior limitation of advanced life support. Participants were excluded if they were pregnant or if their clinician rejected the diagnosis of sepsis in the following days after enrollment. Healthcare workers were enrolled to take part in a control group for the genetic endotypes blood evaluation. Demographic and clinical data were collected. A quantitative real-time PCR (qRT-PCR) was used to quantify 8 genes. A receiver operating characteristic (ROC) curve selected an optimal cut-off value that determined the 4 endotypes: MARS 1, 2 3, and 4.

Resultados

One-hundred-fifty-four participants and twenty-five controls were enrolled. Overall mortality was 42.7%. Non-survivors were older, had higher SOFA scores, higher lactate levels, and used more vasopressors. Mortality was 45% for MARS 2 versus 37.5% for non-MARS 2 (p=0.493), 38.9% for MARS 3 versus 43.3% for non-MARS 3 (p=0.635), 41% for MARS 4 versus 52.9% for non-MARS 4 (p=0.518). MARS 1 showed a higher 28-day mortality (51.7%) than non-MARS 1 group (32.8%), p=0.019.

Conclusão

MARS 1 endotype detected by qRT-PCR is associated with the worst mortality in sepsis in a low-income country.