Identification and analysis of exosome-associated signatures in pediatric sepsis by integrated bioinformatics analysis and machine learning

Background Pediatric sepsis (PS) is a critical condition characterized by life-threatening organ dysfunction and immune dysregulation, including exosome-mediated immune modulation, often linked to infections. Investigating the role of exosome-related genes (ERGs) in the pathogenesis of PS is essential for identifying significant diagnostic and therapeutic targets. Methods Four datasets, namely GSE66099 (training set) and GSE13904, GSE26378, and GSE26440 (validation sets), were retrieved from the Gene Expression Omnibus (GEO). The differential expression of 56 ERGs was analyzed, followed by consensus clustering to identify distinct exosome-related patterns in PS. Weighted gene co-expression network analysis (WGCNA) was utilized to identify PS-related genes (SRGs). Additionally, the immune microenvironment was assessed, and diagnostic models were developed employing specific machine learning algorithms. Results The differential expression analysis identified 21 ERGs that exhibited significant alterations in PS. Consensus clustering revealed two distinct subtypes of PS based on the expression pattern of ERGs. WGCNA identified several hub genes involved in exosome function and PS, with immune-related pathways, including phagocytosis and NF-κB signaling, showing significant enrichment. These genes were leveraged to construct machine learning models, which demonstrated a high diagnostic accuracy, with an area under the curve (AUC) > 0.995. The analysis identified CD177 , GYG1 , IRAK3 , MCEMP1 , and TLR5 as key biomarkers. Furthermore, external validation confirmed the superior performance of the constructed model. Conclusion This study elucidated the role of ERGs in PS, and highlights the significance of immune dysregulation in the pathogenesis of the disease. The developed diagnostic models represent promising tools for the early detection and prognosis prognostic of PS.