An immune dysfunction score for stratification of patients with acute infection based on whole-blood gene expression.

Dysregulated host responses to infection can lead to organ dysfunction and sepsis, causing millions of global deaths each year. To alleviate this burden, improved prognostication and biomarkers of response are urgently needed. We investigated the use of whole-blood transcriptomics for stratification of patients with severe infection by integrating data from 3149 samples from patients with sepsis due to community-acquired pneumonia or fecal peritonitis admitted to intensive care and healthy individuals into a gene expression reference map. We used this map to derive a quantitative sepsis response signature (SRSq) score reflective of immune dysfunction and predictive of clinical outcomes, which can be estimated using a 7- or 12-gene signature. Last, we built a machine learning framework, SepstratifieR, to deploy SRSq in adult and pediatric bacterial and viral sepsis, H1N1 influenza, and COVID-19, demonstrating clinically relevant stratification across diseases and revealing some of the physiological alterations linking immune dysregulation to mortality. Our method enables early identification of individuals with dysfunctional immune profiles, bringing us closer to precision medicine in infection.

Visiting adult patients in intensive care: the importance of relatives' travel and time costs.

UNLABELLED: Families of critically ill patients consistently rate visiting and being near their relative as very important. However, the costs incurred by families whilst visiting have received little attention. This study investigated the personal costs to informal caregivers (families, relatives and friends) visiting critically ill patients in an intensive care unit (ICU). The purpose of the study was (1) to test the feasibility of collecting data from informal caregivers visiting critically ill relatives and (2) to estimate the personal costs incurred by them. Data were collected by self-completed questionnaires over a 2-week period on out-of-pocket expenses and time foregone. RESULTS: One hundred and seven informal caregivers were invited to participate in the study. Fifty-four completed the questionnaire (response 50%). Forty-eight percent of respondents were male and 52% female. Fifty-nine percent of participants were in paid employment, and of these 16% lost wages as a result of the visit. The mean cost of time foregone was 46.21 pounds sterlings /visit (66.92 US dollars) and mean out-of-pocket expenses 29.30 pounds sterlings (42.43 US dollars). CONCLUSION: It is feasible to collect data on expenses and time foregone from informal caregivers visiting the ICU. The main out-of-pocket expense was that related to travel. More empirical work is needed across different settings to obtain more generalisable estimates of out-of-pocket expenses and time foregone.