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

Background: Urosepsis, 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. Methods: The 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. Results: Quantification 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 R-2 value of 0.97 in both biofluids with Q(2) = 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. Conclusions: Our pilot study reveals that H-1 NMR of serum metabolic profiling in combination with PCT levels may provide a rapid method for differentiation of urosepsis. (C) 2015 Elsevier B.V. All rights reserved.