Gene Expression Scoring of Immune Activity Levels for Precision Use of Hydrocortisone in Vasodilatory Shock.
Journal
Shock (Augusta, Ga.)
ISSN: 1540-0514
Titre abrégé: Shock
Pays: United States
ID NLM: 9421564
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
27
1
2022
medline:
22
3
2022
entrez:
26
1
2022
Statut:
ppublish
Résumé
Among patients with vasodilatory shock, gene expression scores may identify different immune states. We aimed to test whether such scores are robust in identifying patients' immune state and predicting response to hydrocortisone treatment in vasodilatory shock. We selected genes to generate continuous scores to define previously established subclasses of sepsis. We used these scores to identify a patient's immune state. We evaluated the potential for these states to assess the differential effect of hydrocortisone in two randomized clinical trials of hydrocortisone versus placebo in vasodilatory shock. We initially identified genes associated with immune-adaptive, immune-innate, immune-coagulant functions. From these genes, 15 were most relevant to generate expression scores related to each of the functions. These scores were used to identify patients as immune-adaptive prevalent (IA-P) and immune-innate prevalent (IN-P). In IA-P patients, hydrocortisone therapy increased 28-day mortality in both trials (43.3% vs 14.7%, P = 0.028) and (57.1% vs 0.0%, P = 0.99). In IN-P patients, this effect was numerically reversed. Gene expression scores identified the immune state of vasodilatory shock patients, one of which (IA-P) identified those who may be harmed by hydrocortisone. Gene expression scores may help advance the field of personalized medicine.
Identifiants
pubmed: 35081076
doi: 10.1097/SHK.0000000000001910
pii: 00024382-202203000-00009
pmc: PMC8868213
doi:
Substances chimiques
Anti-Inflammatory Agents
0
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
384-391Informations de copyright
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Shock Society.
Déclaration de conflit d'intérêts
ROD, LY, RK, EVA, LB, JO, LTF, and DAR are employees of Endpoint Health, Inc. BL and Hl are employees of HypaHub, Inc. ASN reported receiving personal fees from Dräger unrelated to the submitted work and consulting fees from Endpoint Health. RB has no conflict of interest.
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