Comprehensive Integration of Diagnostic Biomarker Analysis and Immune Cell Infiltration Features in Sepsis via Machine Learning and Bioinformatics Techniques

Liuqing Yang ^1* Rui Xuan ^1* Dawei Xu ^1* Aming Sang ^1* jing Zhang ¹ Xinyi Li ^1* Xujun Ye ^2* Yanfang Zhang ^2*

• ¹ Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
• ² Department of Geriatrics, Zhongnan Hospital, Wuhan University, Wuhan, Hebei Province, China

Sepsis, a critical medical condition resulting from an irregular immune response to infection, leads to life-threatening organ dysfunction. Despite medical advancements, the critical need for research into dependable diagnostic markers and precise therapeutic targets. We screened out five gene expression datasets (GSE69063, GSE236713, GSE28750, GSE65682 and GSE137340) from the Gene Expression Omnibus. First, we merged the first two datasets. We then identified differentially expressed genes (DEGs), which were subjected to KEGG and GO enrichment analyses. Following this, we integrated the DEGs with the genes from key modules as determined by Weighted Gene Co-expression Network Analysis (WGCNA), identifying 262 overlapping genes. 12 core genes were subsequently selected using three machine-learning algorithms: random forest (RF), Least Absolute Shrinkage and Selection Operator (LASSO), and Support Vector Machine-Recursive Feature Elimination (SVW-RFE). The utilization of the receiver operating characteristic curve in conjunction with the nomogram model served to authenticate the discriminatory strength and efficacy of the key genes. CIBERSORT was utilized to evaluate the inflammatory and immunological condition of sepsis. Astragalus, Salvia, and Safflower are the primary elements of Xuebijing, commonly used in the clinical treatment of sepsis. Using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), we identified the chemical constituents of these three herbs and their target genes. We found that CD40LG is not only one of the 12 core genes we identified, but also a common target of the active components quercetin, luteolin, and apigenin in these herbs. We extracted the common chemical structure of these active ingredients -flavonoids. Through docking analysis, we further validated the interaction between flavonoids and CD40LG. Lastly, blood samples were collected from healthy individuals and sepsis patients, with and without the administration of Xuebijing, for the extraction of peripheral blood mononuclear cells (PBMCs). By qPCR and WB analysis. We observed significant differences in the expression of CD40LG across the three groups. In this study, we pinpointed candidate hub genes for sepsis and constructed a nomogram for its diagnosis. This research not only provides potential diagnostic evidence for peripheral blood diagnosis of sepsis but also offers insights into the pathogenesis and disease progression of sepsis.