September 22, 2019  |  

Multi-omics approach identifies novel pathogen-derived prognostic biomarkers in patients with Pseudomonas aeruginosa bloodstream infection

Authors: Willmann, Matthias and Goettig, Stephan and Bezdan, Daniela and Macek, Boris and Velic, Ana and Marschal, Matthias and Vogel, Wichard and Flesch, Ingo and Markert, Uwe and Schmidt, Annika and Kuebler, Pierre and Haug, Maria and Javed, Mumina and Jentzsch, Benedikt and Oberhettinger, Philipp and Schuetz, Monika and Bohn, Erwin and Sonnabend, Michael and Klein, Kristina and Autenrieth, Ingo and Ossowski, Stephan and Schwarz, Sandra and Peter, Silke

Pseudomonas aeruginosa is a human pathogen that causes health-care associated blood stream infections (BSI). Although P. aeruginosa BSI are associated with high mortality rates, the clinical relevance of pathogen-derived prognostic biomarker to identify patients at risk for unfavorable outcome remains largely unexplored. We found novel pathogen-derived prognostic biomarker candidates by applying a multi-omics approach on a multicenter sepsis patient cohort. Multi-level Cox regression was used to investigate the relation between patient characteristics and pathogen features (2298 accessory genes, 1078 core protein levels, 107 parsimony-informative variations in reported virulence factors) with 30-day mortality. Our analysis revealed that presence of the helP gene encoding a putative DEAD-box helicase was independently associated with a fatal outcome (hazard ratio 2.01, p = 0.05). helP is located within a region related to the pathogenicity island PAPI-1 in close proximity to a pil gene cluster, which has been associated with horizontal gene transfer. Besides helP, elevated protein levels of the bacterial flagellum protein FliL (hazard ratio 3.44, p < 0.001) and of a bacterioferritin-like protein (hazard ratio 1.74, p = 0.003) increased the risk of death, while high protein levels of a putative aminotransferase were associated with an improved outcome (hazard ratio 0.12, p < 0.001). The prognostic potential of biomarker candidates and clinical factors was confirmed with different machine learning approaches using training and hold-out datasets. The helP genotype appeared the most attractive biomarker for clinical risk stratification due to its relevant predictive power and ease of detection.

Journal: BioRxiv
DOI: 10.1101/309898
Year: 2018

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