Serum procalcitonin levels in combination with 1H NMR spectroscopy: A rapid indicator for differentiation of urosepsis

• A first study that insights 1H NMR metabolic profiling for differentiation of Urosepsis.
• This method requires less than an hour and thus enables effective patient management.
• The unsupervised multivariate analysis identified 4 false positive diseased cases with increased PCT levels.
• Malonate and urea were observed as potential biomarkers in both serum and urine samples.

BackgroundUrosepsis, a severe form of sepsis requires immediate medical attention for prognosis. It is clinically diagnosed by estimating serum procalcitonin (PCT) levels along with time taking urine and blood cultures. We explored NMR based profiling, deriving metabolites that could potentially aid diagnosis.MethodsThe proton NMR of serum and urine samples of healthy control subjects (n = 32) and urosepsis cases (n = 35) based on PCT levels, were analyzed. Four clinically identified non-urosepsis cases with high PCT levels were also differentiated through principal component analysis (PCA) of the serum samples.ResultsQuantification of serum and urine through Discriminant Function Analysis (DFA) afforded 93.7% and 91.7% correct classification respectively, along with identification of malonate and urea as potential biomarkers for the disease in both urine and serum samples. The partial least square discriminant analysis (PLS-DA) showed an R2 value of 0.97 in both biofluids with Q2 = 0.87 and 0.85 for serum and urine respectively. The training set of serum samples provided precise prediction of the test set in a small cohort through random re-sampling method, while in urine samples, the predictions were inconclusive.ConclusionsOur pilot study reveals that 1H NMR of serum metabolic profiling in combination with PCT levels may provide a rapid method for differentiation of urosepsis.

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