Stratification of sepsis patients on admission into the Intensive Care Unit according to differential plasma metabolic phenotypes

Delayed diagnosis of patients with sepsis or septic shock is associated with increased mortality and morbidity. UPLC-MS and NMR spectroscopy were used to measure panels of lipoproteins, lipids, biogenic amines, amino acids and tryptophan pathway metabolites in blood plasma samples collected from 152 patients within 48 hours of admission into the Intensive Care Unit (ICU) where 62 patients had no sepsis, 71 patients had sepsis and 19 patients had septic shock. Patients with sepsis or septic shock had higher concentrations of neopterin and lower levels of HDL cholesterol and phospholipid particles in comparison to non-sepsis patients. Septic shock could be differentiated from sepsis patients based on different concentrations of ten lipids, including significantly lower concentrations of five phosphatidylcholine species, three cholesterol esters, one dihydroceramide and one phosphatidylethanolamine. The Supramolecular Phospholipid Composite was reduced in all ICU patients, while the composite markers of acute phase glycoproteins were increased in the sepsis and septic shock patients within 48 hours admission into ICU. We show that the plasma metabolic phenotype obtained within 48 hours of ICU admission is diagnostic for the presence of sepsis and septic shock can be differentiated from sepsis based on lipid profiles.