The online version of this article (doi:10.1186/cc9102) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
OL, JFR, FC, NG-P, RD, PS and AC participated in the study design. OL, JFR, FC, LC and BH performed the study. OL, JFR, FC and LC processed the data and performed the statistical analysis. OL and FC wrote the manuscript. All authors read and approved the final manuscript.
Neuropeptides arginine-vasopressin (AVP), apelin (APL), and stromal-derived factor-1α (SDF-1α) are involved in the dysfunction of the corticotropic axis observed in septic ICU patients. Study aims were: (i) to portray a distinctive stress-related neuro-corticotropic systemic profile of early sepsis, (ii) to propose a combination data score, for aiding ICU physicians in diagnosing sepsis on admission.
This prospective one-center observational study was carried out in a medical intensive care unit (MICU), tertiary teaching hospital. Seventy-four out of 112 critically ill patients exhibiting systemic inflammatory response syndrome (SIRS) were divided into two groups: proven sepsis and non sepsis, based on post hoc analysis of microbiological criteria and final diagnosis, and compared to healthy volunteers (n = 14). A single blood sampling was performed on admission for measurements of AVP, copeptin, APL, SDF-1α, adrenocorticotropic hormone (ACTH), cortisol baseline and post-stimulation, and procalcitonin (PCT).
Blood baseline ACTH/cortisol ratio was lower and copeptin higher in septic vs. nonseptic patients. SDF-1α was further increased in septic patients vs. normal patients. Cortisol baseline, ACTH, PCT, APACHE II and sepsis scores, and shock on admission, were independent predictors of sepsis diagnosis upon admission. Using the three first aforementioned categorical bio-parameters, a probability score for predicting sepsis yielded an area under the Receiver Operating Curve (ROC) curves better than sepsis score or PCT alone (0.903 vs 0.727 and 0.726: P = 0.005 and P < 0.04, respectively).
The stress response of early admitted ICU patients is different in septic vs. non-septic conditions. A proposed combination of variable score analyses will tentatively help in refining bedside diagnostic tools to efficiently diagnose sepsis after further validation.
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Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga G, Bokhari F, Vogeser M: Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med 2008, 36: 1937-1949. CrossRefPubMed
Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaud P, Bellissant E: Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002, 288: 862-871. CrossRefPubMed
Gallo-Payet N, Roussy JF, Chagnon F, Roberge C, Lesur O: Hypothalamic-pituitary-adrenal axis and MODS in critical illness: special focus on arginine-vasopressin (AVP) and apelin (APL). Journal of Organ Dysfunction 2008, 4: 216-229. CrossRef
Callewaere C, Banisadr G, Desarmenien MG, Mechighel P, Kitabgi P, Rostene WH, Melik Parsadaniantz S: The chemokine SDF-1/CXCL12 modulates the firing pattern of vasopressin neurons and counteracts induced vasopressin release through CXCR4. Proc Natl Acad Sci USA 2006, 103: 8221-8226. PubMedCentralCrossRefPubMed
Jochberger S, Velik-Salchner C, Mayr VD, Luckner G, Wenzel V, Falkensammer G, Ulmer H, Morgenthaler N, Hasibeder W, Dunser MW: The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study. Intensive Care Med 2009, 35: 489-497. CrossRefPubMed
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall JC, Ranieri M, Ramsay G, Sevransky J, Thompson T, Townsend S, Vender JS, Zimmerman , Vincent JL: Surviving Sepsis Campaign guidelines: International guidelines for management of severe sepsis and septic shock. Crit Care Med 2008, 36: 296-327. CrossRefPubMed
Shapiro NI, Trzeciak S, Hollander JE, Birkhahn R, Otero R, Osborn TM, Moretti E, Nguyen HB, Gunnerson KJ, Milzman D, Gaieski DF, Goyal M, Cairns CB, Ngo L, Rivers EP: A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis. Crit Care Med 2009, 37: 96-104. CrossRefPubMed
Dimopoulou I, Stamoulis K, Ilias I, Tzanela M, Lyberopoulos P, Orfanos S, Armaganidis A, Theodorakopoulou M, Tsagarakis S: A prospective study on adrenal cortex responses and outcome prediction in acute critical illness: results from a large cohort of 203 mixed ICU patients. Intensive Care Med 2007, 33: 2116-2121. CrossRefPubMed
Marx C, Petros S, Bornstein SR, Weise M, Wendt M, Menschikowski M, Engelmann L, Hoffken G: Adrenocortical hormones in survivors and nonsurvivors of severe sepsis: diverse time course of dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol. Crit Care Med 2003, 31: 1382-1388. CrossRefPubMed
Lipinier-Fredman D, Sprung CL, Laterre PF, Weiss Y, Goodman SV, Vogeser M, Briegel J, Keh D, Singer M, Moreno R, Bellissant E, Annane D, Corticus Study Group: Adrenal function in sepsis: the retrospective Corticus cohort study. Crit Care Med 2007, 35: 1012-1018. CrossRef
Vermes I, Beishuizen A, Hampsink RM, Haanen C: Dissociation of plasma adrenocorticotropin and cortisol levels in critically ill patients: possible role of endothelin and atrial natriuretic hormone. J Clin Endocrinol Metab 1995, 80: 1238-1242. PubMed
Becchi C, Pillozzi S, Fabbri LP, Al Malyan M, Cacciapuoti C, Della Bella C, Nucera M, Masselli M, Boncinelli S, Arcangeli A, Amedei A: The increase of endothelial progenitor cells in the peripheral blood: a new parameter for detecting onset and severity of sepsis. Int J Immunopathol Pharmacol 2008, 21: 697-705. PubMed
Cribbs S, Rojas M, Taylor R: Circulating endothelial progenitor cells are inversely associated with respiratory organ dysfunction in sepsis. Crit Care Med 2008, 36: A76. CrossRef
Bernhagen J, Krohn R, Lue H, Gregory JL, Zernecke A, Koenen RR, Dewor M, Georgiev I, Schober A, Leng L, Kooistra T, Fingerle-Rowson G, Ghezzi P, Kleemann R, McColl SR, Bucala R, Hickey MJ, Weber C: MIF is a noncognate ligand of CXC chemokine receptors in inflammatory and atherogenic cell recruitment. Nat Med 2007, 13: 587-596. CrossRefPubMed
Russel JA, Walley KR, Gordon AC, Cooper DJ, Hebert PC, Singer J, Holmes CL, Mehta S, Granton JT, Storms MM, Cook DJ, Presneill JJ, Dieter Ayers for the Vasopressin and Septic Shock Trial Investigators: Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock. Crit Care Med 2009, 37: 811-818. CrossRef
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