Pathways Associated With Positive Sepsis Survival Outcomes in African American/Black and Non-Hispanic White Patients With Urinary Tract Infection

Abstract

Urinary tract infections (UTIs) are a common cause of sepsis worldwide. Annually, over 60,000 US deaths can be attributed to sepsis secondary to UTIs, and African American/Black adults have higher incidence and case-fatality rates more so than Non-Hispanic White adults. Molecular-level factors that may help partially explain differences in sepsis survival outcomes between African American/Black and Non-Hispanic White adults are not clear. In this study, patient samples (N = 166) from the Protocolized Care for Early Septic Shock (ProCESS) cohort were analyzed using discovery-based plasma proteomics. Patients had sepsis secondary to UTIs and were stratified according to self-identified racial background and sepsis survival outcomes. Proteomics results suggest patient heterogeneity across mechanisms driving survival from sepsis secondary to UTIs. Differentially-expressed proteins (N = 122, FDR-adjusted p < 0.05) in Non-Hispanic White sepsis survivors were primarily in immune system pathways, while differentially-expressed proteins (N = 47, FDR-adjusted p < 0.05) in African American/Black patients were mostly in metabolic pathways. However, in all patients, regardless of racial background, there were 16 differentially-expressed proteins in sepsis survivors involved in translation initiation and shutdown pathways. These pathways are potential targets for prognostic intervention. Overall, this study provides information about molecular factors that may help explain disparities in sepsis survival outcomes among African American/Black and Non-Hispanic White patients with primary UTIs.