American Journal of Internal Medicine
Volume 3, Issue 1, January 2015, Pages: 6-14
Received: Jan. 25, 2015;
Accepted: Jan. 31, 2015;
Published: Feb. 6, 2015
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Mohammed Amin Abd-Elghany, Intensive Care Medicine Department, Theodor Bilharz Research Institute, Cairo, Egypt
Nahed Salah Eldin, Anesthesia and Intensive Care Medicine Department, Ain Shams University, Cairo, Egypt
Sherif Wadie, Anesthesia and Intensive Care Medicine Department, Ain Shams University, Cairo, Egypt
Mervat Mohammed El Damarawy, Intensive Care Medicine Department, Theodor Bilharz Research Institute, Cairo, Egypt
Fady Adib Abd-El-malek, Anesthesia and Intensive Care Medicine Department, Ain Shams University, Cairo, Egypt
Ashraf Abd El-Khalik Barakat, Intensive Care Medicine Department, Theodor Bilharz Research Institute, Cairo, Egypt
Sepsis is widely diagnosed In ICU patients. The sepsis markers are numerous with variable sensitivity and specificity. Adiponectin is a protein hormone that is secreted from adipose tissue into the bloodstream. It is a key substance in metabolic syndrome and has an anti-inflammatory property. The relationship between adiponectin and sepsis is unclear. In the current study, we aim to demonstrate that low plasma adiponectin level could be an early predictor for morbidity and mortality of sepsis by its comparison with c-reactive protein, serum lactate and procalcitonine. Thirty patients admitted to the intensive care unit with picture clinically suggesting sepsis were enrolled in the study. Predisposition, insult/infection, response, and organ dysfunction (PIRO) score was used to follow the course of the septic process. Plasma adiponectin level, serum lactate level, procalcitonin level(PCT), c-reactive protein(CRP) were checked on day1 then day 4 then day 7 and so on until ICU discharge or demise for a total of 28 days . PIRO score was able to expect sepsis prognosis with high statistical significance. Procalcitonin, serum lactate and adiponectin were valuable in follow up the sepsis prognosis with P value (0, 0.01 & 0 respectively) on the contrary CRP had poor prognostic value in sepsis follow up (P value 0.16).We conclude that PIRO score is an effective model for staging of sepsis and predict mortality. Measuring serial procalcitonin levels may be the most useful in order to understand the trend, identify the peak, and be able to identify resolution of sepsis. Early high lactate level is a predictor for poor prognosis of sepsis. Adiponectin is similar to procalcitinin in early detection of sepsis & can be used as a prognostic indicator with considering that adiponectin level could be affected by other metabolic disorders.
Mohammed Amin Abd-Elghany,
Nahed Salah Eldin,
Mervat Mohammed El Damarawy,
Fady Adib Abd-El-malek,
Ashraf Abd El-Khalik Barakat,
Adiponectin as a Predictor for the Severity of Sepsis in ICU Patients, American Journal of Internal Medicine.
Vol. 3, No. 1,
2015, pp. 6-14.
Skrupky L P, Kerby P W, Hotchkiss R S., 2011: Advances in the management of sepsis and the understanding of key immunologic defects. Anesthesiology; 115 (6): 1349- 1362.
Le Gall JR, Alberti C, Brun Buisson C., 2004: [Epidemiology of infection and sepsis in intensive care unit patients]. Bull Acad Natl Med; 188(7):1115-25
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis, Crit Care Med; 20:864–74.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G. SCCM/ESICM/ACCP/ATS/SIS: 2001 SCCM/ ESICM/ ACCP/ ATS/ SIS, 2003: International Sepsis Definitions Conference. Crit Care Med; 31:1250–6.
Annane D, Bellissant E, Cavaillon JM., 2005: Septic shock. Lancet; 365:63.
Neviere R., 2012: Sepsis and the systemic inflammatory response syndrome: Definitions, epidemiology, and prognosis. Up to date, may, Parsons, PE (Ed).
Hotchkiss RS, Karl IE., 2003: The pathophysiology and treatment of sepsis. N Engl J Med; 348:138-150.
Russell JA., 2006: Management of Sepsis. N Engl J Med; 355:1699-1713.
Perren A, Cerutti B, Lepori M, et al., 2008: Influence of steroids on procalcitonin and C-reactive protein in patients with COPD and community-acquired pneumonia. Infection; 36: 163-6.
Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, Vadas L, Pugin J., 2001: Geneva Sepsis Network: Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med; 164:396-402.
Ho KM, Towler SC. A., 2009: comparison of eosinopenia and C-reactive protein as a marker of bloodstream infections in critically ill patients: a case–control study. Anaesth Intensive Care; 37:450-6.
Guignant C, Voirin N, Venet F, et al., 2009: Assessment of pro-vasopressin and pro-adrenomedullin as predictors of 28-day mortality in septic shock patients. Intensive Care Med; 35:1859-67.
Seligman R, Papassotiriou J, Morgenthaler NG, et al., 2008: Prognostic value of midregional pro-atrial natriuretic peptide in ventilator-associated pneumonia. Intensive Care Med; 34:2084-91.
Wu HP,Chen CK,Chung K,et al., 2009: Plasma transforming growth factor-β1 level in patients with severe community-acquired pneumonia and association with disease severity. J Formos Med Assoc; 108: 20-7.
Koch A, Gressner OA, Sanson E, et al. 2009: Serum resistin levels in critically ill patients are associated with inflammation, organ dysfunction and metabolism and may predict survival of non-septic patients. Crit Care;13: 95.
Davis BH and Bigelow NC, 2005: Comparison of neutrophil CD64 expression, manual myeloid immaturity counts, and automated hematology analyzer flags as indicators of infection or sepsis.Lab Hematol;11:137–47.
Habib AM, Russo A, Zakariah AN, et al., 2005: Diagnosing Sepsis—Markers, Microarrays, and Multiplexes Intensive Care Med; 31(Suppl. 1):036 (abstr.).
Marshall JC, Vincent JL, Fink MP, et al., 2003: Measures, markers, and mediators: toward a staging system for clinical sepsis. Crit Care Med; 31: 1560–67.
Lobo SM, Lobo FR, Bota DP, et al., 2003: C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest; 123: 2043–9.
Meisner M, Tschaikowsky K, Palmaers T, Schmidt J., 1999: Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS Crit Care; 3: 45–50.
O'Grady NP, Barie PS, Bartlett JG, et al., 2008: Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med; 36: 1330-49.
Claeys R, Vinken S, Spapen H, et al., 2002: Plasma procalcitonin and C-reactive protein in acute septic shock: clinical and biological correlates.Crit Care Med; 30: 757–62.
Christ-Crain M, Stolz D, Bingisser R, et al., 2006: Procalcitonin guidance of antibiotic therapy in community.Am J Respir Crit Care Med; 174: 84–93.
Gunnerson K J, Saul M, He S, and Kellum J A., 2006: Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care; 10(1): 22.
Trzeciak S, Dellinger RP, Chansky ME, Arnold RC, Schorr C, Milcarek B, Hollenberg SM, Parrillo JE., 2007: Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med; 33: 970-977.
Bercault N, Boulain T, Kuteifan K. et al., 2004: Obesity-related excess mortality rate in an adult intensive care unit: A risk-adjusted matched cohort study. Crit Care Med; 32: 998–1003.
Koerner A, Kratzsch J, Kiess W., 2005: Adipocytokines: leptin – the classical, resistin – the controversial, adiponectin – the promising, and more to come. Best Pract Res Clin Endocrinol Metab; 19: 525-546.
Arita Y, Kihara S, Ouchi N. et al., 1999: Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun; 257: 79–83.
Gil-Campos, M., Canete, R., & Gil, A., 2004: Adiponectin, the missing link in insulin resistance and obesity. Clinical Nutrition; 23, 963-974.
Tilg H and Moschen AR., 2006: Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol; 6: 772-783.
Kougias P, Chai H, Lin PH, Lumsden AB, Yao Q, Chen C., 2005: Adipocyte-derived cytokine resistin causes endothelial dysfunction of porcine coronary arteries. J Vasc Surg; 41:691-698.
Oberholzer A, Oberholzer C, Moldawer L L., 2001: Sepsis syndromes: understanding the role of innate and acquired immunity. Shock; 16: 83-96.
Teoh H, Quan A, Bang KW, Wang G, Lovren F, Vu V, Haitsma JJ, Szmitko PE, Al-Omran M, Wang CH, Gupta M, Peterson MD, Zhang H, Chan L, Freedman J, Sweeney G, Verma S., 2008: Adiponectin deficiency promotes endothelial activation and profoundly exacerbates sepsis-related mortality. Am J Physiol Endocrinol Metab; 295: 658–664.
Retnakaran R, Zinman B, Connelly PW, Harris SB, Hanley AJ., 2006: Nontraditional cardiovascular risk factors in pediatric metabolic syndrome. J Pediatr; 148: 149-151.
Iwashima Y, Katsuya T, Ishikawa K, Ouchi N, Ohishi M, Sugimoto K et al., 2004: Hypoadiponectinemia is an independent risk factor for hypertension. Hypertension; 43: 1318-1323.
Rubulotta F, Marshall JC, Ramsay G, Nelson D, Levy M, Williams M., 2009: Predisposition, insult/infection, response, and organ dysfunction: A new model for staging severe sepsis. Crit Care Med; 37(4): 1329-35.
Rello J, Rodriguez A, Lisboa T, Gallego M, Lujan M, Wunderink R., 2009: PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med; 37(2): 456-62.
Furtado GH, Wiskirchen DE, Kuti JL, Nicolau DR., 2012: Performance of the PIRO score for predicting mortality in patients with ventilator-associated pneumonia. Anaesthesia & Intensive Care; 40 (2), 285.
Orlando D and Endaya, MD., 2012: Ventilator-Associated Pneumonia & PIRO Score Philippine Heart Center; 16: 82-83.
Póvoa P, Almeida E, Moreira P, et al., 1998: C-reactive protein as an indicator of sepsis Intensive Care Med; 24: 1052–6.
Gokmen Z, Ozkiraz S, Kulaksizoglu S, Kilicdag H, Ozel D, Ecevit A, Tarcan A., 2013: Resistin-A Novel Feature in the Diagnosis of Sepsis in Premature Neonates. Am J Perinatol; 30(6) :513-7.
Giamarellos-Bourboulis EJ, Mega A, Grecka P, et al., 2002: Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient? Intensive Care Med; 28: 1351-6.
Jensen JU, Heslet L, Jensen TH, et al., 2006: Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med; 34:2596-602.
Schuetz P., 2012: Role of Procalcitonin in Managing Adult Patients with Respiratory Tract Infections. Chest; 141:1063-1073.
Bakker J and Jansen T C., 2007: Don't take vitals, take a lactate; Intensive Care Med.; 33(11): 1863–1865.
Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich M C., 2004: Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med.; 32: 1637–1642.
Van Meurs M, Castro P, Shapiro NI, Lu S, Yano M, Maeda N, Funahashi T, Shimomura I, Zijlstra JG, Molema G, Parikh SM, Aird WC, Yano K., 2012: Adiponectin diminishes organ-specific microvascular endothelial cell activation associated with sepsis. Shock; 37(4): 392-8
Uji Y, Yamamoto H, Maeda K, Tsuchihashi H, Akabori H, Shimizu T, Endo Y, Shimomura I, Tani T., 2010: Adiponectin deficiency promotes the production of inflammatory mediators while severely exacerbating hepatic injury in mice with polymicrobial sepsis. J Surg Res.; 161(2): 301-11.
Yamamoto H, Maeda K, Uji Y, Tsuchihashi H, Mori T, Shimizu T, Endo Y, Kadota A, Miura K, Koga Y, Ito T, Tani T., 2013: Association between Reduction of Plasma Adiponectin Levels and Risk of Bacterial Infection after Gastric Cancer Surgery. Tani Surgery.PLoS One; 8(3):e56129