H3.1 Nucleosomes to Predict Renal Replacement Therapy and Mortality in Sepsis-A Secondary Analysis of the SISPCT Randomized Control Trial.
Crit Care MedAug 3, 2026 (epub)
Caroline Neumann, Frank Bloos, Teddy Tun Win Hla et al.
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In 30 seconds
This secondary analysis of the SISPCT randomized controlled trial evaluated H3.1 nucleosome levels in 971 patients with sepsis and septic shock. It found that higher admission H3.1 levels were associated with increased 28-day mortality and a greater likelihood of requiring renal replacement therapy (RRT). Specifically, a one unit increase in log10 H3.1 levels correlated with a 48% increase in mortality (HR 1.48).
Key findings
- Admission H3.1 levels were significantly higher in septic shock patients compared to those with sepsis (921.84 vs 432.71 ng/mL; p < 0.001).
- A one unit increase in log10 H3.1 levels was associated with a 48% increase in 28-day mortality (HR 1.48; p = 0.02).
- Patients with stage 3 AKI requiring RRT had higher H3.1 levels compared to those without AKI (1832 vs 801.4 ng/mL; p = 0.01).
- A one log10 increase in H3.1 levels increased the risk of 28-day RRT by 80% (HR 1.8; p < 0.001).
Why it matters
Understanding the role of H3.1 nucleosomes as predictive biomarkers for mortality and renal replacement therapy in sepsis can help clinicians identify high-risk patients and potentially guide management strategies.