Physicians and researchers at Our Lady of the Lake Regional Medical Center are launching a new study that they hope will help to determine which coronavirus patients have the most serious and life-threatening cases.
Dr. Bud O’Neal, the hospital’s medical director of research, has spent years studying cells for signs that a patient has sepsis — meaning an infection in their body has triggered an immune response that can inflict damage on all bodily systems and lead to death.
Most of the time, bacterial infections trigger sepsis. But O’Neal believes that Our Lady of the Lake’s sickest coronavirus patients have sepsis not from bacteria, but from the viral pathogen that causes the virus.
Knowing early on whether a coronavirus patient is at high risk for sepsis could be a game-changer in making sure that those patients immediately receive aggressive treatment before they begin to deteriorate.
“We can identify those patients who are highest risk and admit them to the hospital, versus those who are lowest risk and send them home,” said O’Neal, who is also a critical care and pulmonology specialist and LSU Health Sciences professor who’s been treating intensive care coronavirus patients.
Early recognition of patients who are going to be especially sick from sepsis combined with coronavirus could help hospitals as they face potential shortages of beds, ventilators and personal protective equipment.
So far, O’Neal and his team have enrolled 280 patients in their pilot study, and most of them are suspected coronavirus patients. Researchers will use technology from a California-based company, Cytovale Inc., to analyze their blood and to look closely at their white blood cells. They’ve been using Cytovale’s technology to research sepsis since 2014.
The squishier someone’s white blood cells appear, the more likely they are to have a severe infection, O’Neal said. White blood cells are normally firm, but they change properties when they become activated to fight infections.
“Patients with highly deformable white blood cells — they’re much more likely to be sicker, longer stays in the hospital, longer stays in the ICU, to have sepsis,” O’Neal said.
The results of the blood tests analyzing white blood cells can have a rapid turnaround time, taking just 10 minutes in a lab. The tests are not meant to find the underlying reason why someone has sepsis or the type of pathogen that caused it, but rather to show whether someone’s body is trying to fight it.
Normally, confirming a sepsis diagnosis would require a few days to grow blood cultures. That lag in suspecting that a patient has sepsis but not knowing for sure can be costly.
Treating sepsis requires an aggressive and immediate response. Patients who are highly suspected of having it are usually admitted to the ICU and treated with antibiotics, O’Neal said. But other conditions — cancer, inflammatory diseases, heart conditions — can also mimic sepsis, he said. And if physicians treat a patient for sepsis who does not actually have it, those treatments can cause long-term damage.
Our Lady of the Lake’s sepsis research is still in early stages and cannot yet be used for treatment decisions, O’Neal said. He said they’re nearing the start of a study for approval from the U.S. Food and Drug Administration.
The FDA could potentially give the researchers an “emergency use authorization” amid the pandemic to start using the tests to identify the most at-risk coronavirus patients for sepsis. Eventually, O’Neal said they hope to gain full FDA approval for sepsis testing in other emergency room patients as well.