Viral Infections in Patients with Severe Sepsis

Bacterial infections are the most common cause of sepsis, however almost any virus can lead to the development of sepsis. Indeed, some patients with existing viral infections, such as influenza, can further develop a severe bacterial infection in addition to the existing viral condition, thus increasing the overall severity of the condition and complicating treatment strategies.

In a recent investigation across 5 intensive care units (ICU), Valenzuela Sanchez et al. (2015) investigated patients with severe pneumonia who had progressed onto severe sepsis due to the Influenza A virus. Biomarker concentrations (CRP, PCT and MR-proADM) were measured on ICU admission and compared to a control group of patients not admitted to the ICU.

PCT and CRP levels were similar in both patient groups, yet MR-proADM levels were significantly increased in the patients admitted onto the ICU.

  

Not admitted to the ICU
(CG)

  ICU influenza A virus pneumonia  
(IAvPN)

p

Median IQR Median IQR
  CRP (mg/dl)
  Admission
6.37 2.5-10.93 9.2 5.6-14.3 p=0.112
  PCT (μg/l)
  Admission
0.3 0.100-1.175 0.27 0.155-0.700    p=0.8689   
  MR-proADM (nmol/l)
  Admission
0.5437 0.404-0.891 1.40 0.994-2.374 p<0.001

Figure 1: Initial CRP, PCT and MR-proADM levels


AUROC values were higher for MR-proADM (0.87) compared to either PCT (0.68) or CRP (0.58) in accurately identifying the requirement for ICU admission, as well as identifying the likelihood of 28 day mortality (MR-proADM: 0.84; PCT: 0.60; CRP: 0.64).

Initial MR-proADM levels may therefore be useful in patients with pneumonia due to the Influenza A virus in predicting the risk of ICU admission and an unfavourable outcome.

thermo scientific applied biosystems invitrogen fisher scientific unity lab service