The roles of interleukin-17A in risk stratification and prognosis of patients with sepsis-associated acute kidney injury

Biomarkers as Beacons: Illuminating Sepsis-Associated Hepato-Renal Injury

Sepsis, defined as a dysregulated host response to infection, is one of the leading causes of mortality worldwide. It unleashes in the organism a cascade of molecules, cytokines, and proteins which leads to an inflammatory storm. If this response to infection is uncontrolled, any organ is susceptible to damage. Acute kidney injury (AKI) is one of the most frequent organ dysfunctions in septic patients, and while it can be reversible, its presence leads to a higher burden of morbidity and mortality. While serum creatinine is essential in evaluating kidney function, the pathophysiology of AKI is not completely elucidated, and a plethora of novel biomarkers have been studied in the hope of an early diagnosis and fast treatment. While the liver is not as affected by sepsis, it plays an important role as a guardian by providing acute-phase proteins, activating neutrophils, and controlling iron balance. Acute liver failure (ALF) could impair the organism's capacity to contain and eliminate pathogens. Some molecules have been associated with either AKI or ALF, although biomarkers specific for organ dysfunction are difficult to validate. The aim of this review is to understand the role of several molecules in the pathophysiology of sepsis and their clinical ability for diagnosing or predicting sepsis-induced hepato-renal dysfunction.

A bidirectional mendelian-randomization analyses of genetically predicted circulating levels of systemic inflammatory regulators with risk of sepsis

Whether there is a causal relationship between circulating levels of systemic inflammatory regulators and sepsis remains unclear. To determine whether genetically predicted circulating levels of cytokines are associated with risk of sepsis, a bidirectional two-sample Mendelian randomization (MR) analysis based on the a STROBE-compliant cross-sectional observational study was conducted utilizing gene-wide association study (GWAS) data. Selected with rigor, single-nucleotide polymorphisms served as instrumental variables for subsequent MR analysis. The preferred method for the MR analysis was the inverse-variance weighted approach. However, for comprehensive sensitivity analyses, 6 additional MR methods were employed. Cochrane's Q test was performed to examine heterogeneity. A leave-one-out method ensured the stability of MR results. Our findings suggest an inverse association between the levels of beta-nerve growth factor (BNGF) and the risk of sepsis development (OR = 0.769, 95% CI = 0.599-0.987, P = .039). In contrast, higher levels of TNF-related apoptosis-inducing ligand and vascular endothelial growth factor A (VEGF-A) are positively correlated with sepsis risk (OR = 1.094, 95% CI = 1.012-1.183, P = .025; OR = 1.182, 95% CI = 1.016-1.375, P = .031, respectively). Reverse MR Analysis indicated that sepsis risk is linked with lower circulating levels of adenosine deaminase and Interleukin-17A (β = -0.043, 95% CI = -0.085 to -0.002, P = .042; β = -0.061, 95% CI = -0.108 to -0.013, P = .012, respectively), and also with higher circulating levels of BNGF, delta/notchlike epidermal growth factor-related receptor, fibroblast growth factor 23, leukemia inhibitory factor, monocyte chemoattractant protein-1, and osteoprotegerin (β = 0.056, 95% CI = 0.015-0.096, P = .007; β = 0.137, 95% CI = 0.035-0.240, P = .009; β = 0.118, 95% CI = 0.020-0.216, P = .018; β = 0.136, 95% CI = 0.020-0.252, P = .022; β = 0.143, 95% CI = 0.043-0.242, P = .005; β = 0.116, 95% CI = 0.010-0.222, P = .031, respectively). Sum up, our study provides evidence supporting a bidirectional causal relationship between sepsis and genetically predicted circulating levels of systemic inflammatory regulators.

The Impact of Steatotic Liver Disease on Cytokine and Chemokine Kinetics During Sepsis

Metabolic dysfunction-associated steatotic liver disease (MASLD) has recently been linked with sepsis outcomes. However, the immune mechanisms by which MASLD aggravates sepsis severity are unknown. This prospective cohort study aimed to analyze serum cytokine and chemokine kinetics in patients with MASLD and community-acquired sepsis. Out of the 124 patients, 68 (55%) were diagnosed with MASLD. There were no differences in age, sex, comorbidities, baseline sepsis severity, or etiology between the groups. Serum concentrations of 27 cytokines and chemokines on admission and day 5 of hospitalization were analyzed using a multiplex bead-based assay. Patients with MASLD had significantly higher serum concentrations of IL17A, IL-23, IL-33, CXCL10 and TGF-β1. Different cytokine kinetics were observed; patients with MASLD had a decrease in IL-10, IL-23, CXCL10 and TGF-β1, and an increase in IL-33, CXCL5 and CXCL1 on day 5. In the non-MASLD group, there was a decrease in IFN-γ, IL-6, IL-23 and CCL20, and an increase in CCL11 and CXCL5. While TGF-β1 significantly increased in non-MASLD, in MASLD, it decreased on day 5. Kinetics of TGF- β1 and CCL11 were associated with mortality in patients with MASLD. In conclusion, MASLD is linked with distinct cytokine and chemokine profiles during sepsis.