TY - JOUR

T1 - Systemic immune activation profiles in streptococcal necrotizing soft tissue infections

T2 - A prospective multicenter study

AU - Rath, Eivind

AU - Palma Medina, Laura M.

AU - Jahagirdar, Sanjeevan

AU - Mosevoll, Knut A.

AU - Damås, Jan K.

AU - Madsen, Martin B.

AU - Svensson, Mattias

AU - Hyldegaard, Ole

AU - Martins dos Santos, Vitor A.P.

AU - Saccenti, Edoardo

AU - Norrby-Teglund, Anna

AU - Skrede, Steinar

AU - Bruun, Trond

AU - INFECT Study Group

N1 - Publisher Copyright: © 2023 The Authors

PY - 2023

Y1 - 2023

N2 - Objective: Early stages with streptococcal necrotizing soft tissue infections (NSTIs) are often difficult to discern from cellulitis. Increased insight into inflammatory responses in streptococcal disease may guide correct interventions and discovery of novel diagnostic targets. Methods: Plasma levels of 37 mediators, leucocytes and CRP from 102 patients with β-hemolytic streptococcal NSTI derived from a prospective Scandinavian multicentre study were compared to those of 23 cases of streptococcal cellulitis. Hierarchical cluster analyses were also performed. Results: Differences in mediator levels between NSTI and cellulitis cases were revealed, in particular for IL-1β, TNFα and CXCL8 (AUC >0.90). Across streptococcal NSTI etiologies, eight biomarkers separated cases with septic shock from those without, and four mediators predicted a severe outcome. Conclusion: Several inflammatory mediators and wider profiles were identified as potential biomarkers of NSTI. Associations of biomarker levels to type of infection and outcomes may be utilized to improve patient care and outcomes.

AB - Objective: Early stages with streptococcal necrotizing soft tissue infections (NSTIs) are often difficult to discern from cellulitis. Increased insight into inflammatory responses in streptococcal disease may guide correct interventions and discovery of novel diagnostic targets. Methods: Plasma levels of 37 mediators, leucocytes and CRP from 102 patients with β-hemolytic streptococcal NSTI derived from a prospective Scandinavian multicentre study were compared to those of 23 cases of streptococcal cellulitis. Hierarchical cluster analyses were also performed. Results: Differences in mediator levels between NSTI and cellulitis cases were revealed, in particular for IL-1β, TNFα and CXCL8 (AUC >0.90). Across streptococcal NSTI etiologies, eight biomarkers separated cases with septic shock from those without, and four mediators predicted a severe outcome. Conclusion: Several inflammatory mediators and wider profiles were identified as potential biomarkers of NSTI. Associations of biomarker levels to type of infection and outcomes may be utilized to improve patient care and outcomes.

KW - Biomarker

KW - Cellulitis

KW - Necrotizing fasciitis

KW - NSTI

KW - Streptococcus dysgalactiae

KW - Streptococcus pyogenes

U2 - 10.1016/j.clim.2023.109276

DO - 10.1016/j.clim.2023.109276

M3 - Journal article

C2 - 36871764

AN - SCOPUS:85150038685

VL - 249

JO - Clinical Immunology

JF - Clinical Immunology

SN - 1521-6616

M1 - 109276

ER -