The macrophage activation marker sMR as a diagnostic and prognostic marker in patients with acute infectious disease with or without sepsis

Abstract

Sepsis is a leading cause of mortality. This study aims to assess the utility of the soluble mannose receptor (sMR) as a biomarker of sepsis and mortality in patients hospitalized with suspected infection. Using an in-house ELISA assay the concentration of sMR was analyzed in the serum of patients from three prospective studies. Using Sepsis-3 guidelines, patients were stratified as no infection (NI, n = 68), verified infection without sepsis (NSEP, n = 133) and verified infection with sepsis (SEP, n = 190). Adverse outcome was assessed as death before 28 days. We show that the sensitivity of sMR to predict mortality [area under curve (AUC) = 0.77] exceeded the sensitivity of procalcitonin (PCT, AUC = 0.63), C-reactive protein (CRP, AUC = 0.61) and the macrophage soluble receptor, CD163 (sCD163, AUC = 0.74), while it was less accurate to predict diagnosis of sepsis [AUC(sMR) = 0.69 vs. AUC(PCT) = 0.79, AUC(CRP) = 0.71 and AUC(sCD163) = 0.66]. Median sMR was significantly higher in the group with SEP (0.55 mg/L), compared with the groups without sepsis (NI and NSEP) (0.39 mg/L, p < .0001), and among those who died compared to those who survived (0.89 mg/L vs. 0.44 mg/L, p < .0001). Our results, and the current literature, support further evaluation of sMR as a biomarker of sepsis and mortality among patients hospitalized with suspected infection.

Keywords:

• Infection
• soluble mannose receptor
• sCD206
• biomarker
• sepsis-3
• bacteremia
• acute medicine

Ethics

Data and blood sample collection in the three original studies were done in accordance with the Declaration of Helsinki and ethical allowances were obtained from the Scientific Ethical Committee of Southern Denmark (Funen and Vejle Counties, file number 20010076) and from the Danish Data Security Board (2003). Written informed consent was obtained from the patients or closest relatives in each case.

After completion of the original studies, all data and samples were completely and irrevocably anonymized, so that the material cannot be directly or indirectly attributed to the donor with the means that may reasonably be used to identify the person concerned. According to Danish law, research on anonymized data can be done without obtaining new approval from the Ethical Committee and data Protection Agency if the original data collection was done in accordance with all rules.

Geolocation information

The geographical location (geolocation) of Odense in Denmark is on the north and east hemisphere.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets used are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by Region of Southern Denmark’s Research foundation.