(1569) Exploring the Significance of NETs in Septic Cancer Patients

Introduction: Early identification of sepsis is crucial to improve outcome and reduce mortality, particularly in cancer patients who are higher risk of mortality due to sepsis. Neutrophil Extracellular Traps (NETs) have emerged as a promising area of research, being structures composed of DNA, histones and antimicrobial proteins that are released by neutrophils in response to infections. We hypothesize that NETs could serve as potential biomarkers for early diagnosis of sepsis in cancer patients.

Methods: This is a single-site prospective observational study of solid tumor patients with and without sepsis. Sepsis-3 criteria was used to identify patients with sepsis. Neutrophils were purified from blood samples at hospital admission by negative selection and cytocentrifuged on glass slides. Cells were visualized with the fluorescent DNA dye Sytox Green. The percentage of NETs was calculated by dividing the number of NET-forming neutrophils by the total number of cells in 10 randomly selected microscopic fields and multiplying by 100. Non-normally distributed variables were described using median and interquartile range (IQR) and were compared using the Mann-Whitney U test. Additionally, an area under the curve (AUC) was calculated. A p-value < 0.05 was considered statistically significant.

Results: Forty-eight patients were analyzed, with 47.9% (23/48) controls, and 52.1% (25/48) with sepsis. A statistically significant difference in NET% on hospital admission was observed between septic patients and controls (19% vs 8%, p=0.001). The AUC for NET% differentiating septic patients from controls was 0.71 (p=0.01). The average NET% in septic patients was 19% and demonstrated a sensitivity of 82.6% and a specificity of 48%.

Conclusions: The study found a significantly higher NET% in septic patients compared to controls. This finding highlights a possible relationship between elevated levels of NETs and sepsis in patients with solid tumors. However, more research is needed to understand the role of NETs in sepsis, including how they are generated, regulated, and their impact on early diagnosis, disease progression, possible treatment and clinical outcomes.