Authors
Shevchenko Yu.L., Fedyk O.V., Shcheparev I.S.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Objective. To summarize the evolution of laboratory and digital approaches to early diagnosis and prediction of infectious complications in surgery, from classical leukocyte intoxication indices to artificial intelligence–based systems.
Materials and methods. A targeted literature analysis was performed on leukocyte intoxication indices, composite hematologic indices (NLR, PLR, SII, DNI), biochemical markers (C reactive protein, procalcitonin, presepsin), novel hematology analyzer parameters (MDW), immunophenotypic markers (monocytic HLA DR, CD14/CD16 subsets), metagenomic next-generation sequencing (mNGS), and machine learning models for early sepsis detection.
Results. Classical leukocyte indices remain useful as inexpensive tools for risk stratification but are limited by subjectivity and low specificity for bacterial infection. Composite hematologic indices and MDW improve early sepsis detection by leveraging routinely available complete blood count data. Biochemical markers, particularly procalcitonin and presepsin, provide higher diagnostic and prognostic accuracy, yet are influenced by surgical trauma and require careful interpretation of their kinetics. Immunophenotypic markers of monocytes reflect functional reprogramming of innate immunity and allow assessment of immune dysregulation. mNGS markedly increases pathogen detection rates and shortens time to etiologic diagnosis, but its use is constrained by high cost and technical complexity. Machine learning models based on electronic health record data outperform traditional scores (SIRS, qSOFA) for early sepsis prediction, while facing challenges of overfitting, alarm fatigue and limited external validation.
Conclusions. Modern strategies for early detection of infectious complications in surgical patients should rely on integrated use of readily available hematologic and biochemical markers, immunophenotyping, and AI driven tools embedded in electronic health records. Standardization of assays, economic evaluation and multicenter validation are crucial prerequisites for widespread clinical implementation.
Keywords: sepsis, postoperative infectious complications, leukocyte intoxication index, neutrophil to lymphocyte ratio, procalcitonin, presepsin, monocyte distribution width, HLA DR, CD14/CD16, metagenomic next generation sequencing, artificial intelligence.
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