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01.08.2010 | Research | Ausgabe 4/2010 Open Access

Critical Care 4/2010

Proven infection-related sepsis induces a differential stress response early after ICU admission

Zeitschrift:
Critical Care > Ausgabe 4/2010
Autoren:
Olivier Lesur, Jean-Francois Roussy, Frederic Chagnon, Nicole Gallo-Payet, Robert Dumaine, Philippe Sarret, Ahmed Chraibi, Lucie Chouinard, Bruno Hogue
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​cc9102) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

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.

Abstract

Introduction

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.

Methods

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).

Results

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).

Conclusions

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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