Summary:
ABSTRACT Introduction. Sepsis is a major cause of morbidity and mortality in
ICU area. The endothelium plays a critical role in the pathophysiology of
sepsis. Several endothelial biomarkers expressed during sepsis without,
however, standardized levels, that would be useful tools for prognosis,
diagnosis and outcome of sepsis.
Objective. Assessment of microcirculation by near infrared spectroscopy (NIRS)
method in combination with Vascular Occlusion Technique (VOT) during sepsis and
determination of biomarkers in prognosis of sepsis syndrome.
Material–Methods. The study involved 187 non-septic critically ill patients, of
whom one hundred twenty two met the inclusion criteria. To estimate the
condition of microcirculation we used NIRS technology in combination with
vascular occlusion technique in peripheral muscle. Measurements by this method
were in four time points: at admission day in ICU, on sepsis day, 24h and 48h
after sepsis presence. For the determination of different biomarkers we used
ELISA assay, RT-PCR, etc.
Results. From one hundrend twenty two non-septic critically ill patients who
included in our study, 71 of them, developed sepsis during their stay in ICU
while 51 were used as control group (non-septic patients). NIRS measurements of
septic patients (N=71) have impaired oxygen consumption rate in sepsis day
compared with their baseline. Furthermore, hyperemia recovery time was
significantly lower on the sepsis day compared to baseline (137±50sec, vs
169±30sec, p<0.001). This parameter continued to decrease during subsequent
time points, at 24hrs and 48hrs after sepsis. Hyperemia recovery area showed
significant differences between baseline and sepsis day (19.3±10.6,vs 12.4±8.
6,p<0.001), 24hrs (10.7±7.5, p<0.001) and 48hrs (10±4.7,p<0.001). From all
biomarkers (sP-selectin , sE-selectin , Ang-1, Ang-2, VE-cadherin, sICAM-1,
TNF-α, VEGF, vWf) only sE-selectin and sP- selectin levels were increased at
admission day in patients who developed sepsis compared with non-septic
patients. By analyzing the results of EPCR we observed increased levels in
patients who developed sepsis during their stay in ICU compared with non-septic
patients. Multivariate analysis showed that sEPCR is the only factor associated
with the development of sepsis with time. Finally, Aqp-1 was increased in
polymorphonuclear granulocytes in septic patients , while it increased 3-fold
at the onset of septic shock.Conclusions. Our results support the view that the
endothelium function is disrupted by appearance of sepsis syndrome. NIRS
measurements are associated with microcirculatory alterations in critically ill
patients at the early stage of sepsis. Furthermore, sEPCR, sE-selectin and
sP-selectin appear to be key factors in the development of sepsis suggesting
that they could be used as prognostic biomarkers of sepsis. Finally Aqp-1
induction is associated with increased cell membrane permeability and may
therefore be of probable functional significance.
Keywords:
Endothelium, Sepsis, Near infrared spectroscopy, Biomarkers, ICU
