Supervisors info:
Μαριάννα Πολίτου, Αναπ. Καθηγήτρια, Ιατρική, ΕΚΠΑ
Ιωάννης Βασιλειάδης, Επ. Καθηγητής, Ιατρική, ΕΚΠΑ
Ευάγγελος Τέρπος, Αναπ. Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Thrombomodulin (TM) is a membrane, glycoprotein receptor found on the surface of endothelial cells in large amounts, especially in the microcirculation, which acts as an anticoagulant. During sepsis, expression of TM on the surface of the activated endothelial decreases due to discharge of the molecule while its concentration in serum increases. This indicates an endothelial dysfunction while TM is thought to exert a protective effect on the endothelium during sepsis. The levels of TM in the development of sepsis have not been adequately studied. The purpose of this study was to evaluate the endothelial dysfunction by measuring TM levels in ICU patients with severe sepsis / septic shock, at admission and for significant deterioration.
METHODS
11 patients admitted to the ICU of a public hospital from February to March of 2015 were studied, of whom six were men and five were women,Median age was 70.55 ± 8.94 years and the BMI was 28.17 ± 6.46 Kg / m2. APACHE SCORE on admission was 22.45 ± 4.72 and SOFA SCORE admission was 10.09 ± 3.42. Patients had severe sepsis / septic shock, and despite of the applied treatment and support of their vital functions, they showed a significant deterioration. This deterioration was defined as an increase in the need for vasoactives or an increase in lactate levels, and an overall increase in SOFA score.Eigth ( 8) of the patients had lower respiratory tract infection (with identification of the infectious cause in two of them: Rhinovirus and Klebsiella pneumoniae) while the rest of them showed: infectious pericarditis in soil cancerous dispersion, peritonitis after gastric perforation (from peritonial fluid isolated Staphylococcus aureus and Streptococcus anginosus) and mediastinitis (Streptococcus constellatus). Recording of basic clinical and laboratory parameters during their admission and the 24-hour deterioration was done while TM levels were measured in serum of patients at the same time.
RESULTS
Among eleven patients ten of them pass away. During patient follow up in the phase of deterioration. a) we found an increase of SOFA SCORE (12.18 ± 4.07 vs 10.09 ± 3.42, p = 0.006),in relation to their admission, b) increase of the average noradrenaline dose during a 24 hour period (0.424 ± 0.236 vs 0.185 ± 0.136 mcg / kg / min, p = 0.004) c) increase of the leukocytes number (24797 ± 13465 vs 18271 ± 9269 /ML, p = 0.02) and d) a decrease in hemoglobin (9.90 ± 1.45 vs 11.56 ± 1.85 g /dl, p= 0.004) and platelet count (161518 ± 127506 vs 254955 ± 119552 / ML, p = 0.064). Also an increase of the levels of lactic acid (3.77 ± 3.20 vs 1.98 ± 0.96 mmol /l, p = 0.076) and base deficit (1.69 ± 4.13 vs -4.12 ± 7.50 mmol /l, p = 0.075) was observed, while the concentration of albumin decreased significantly (1.60 ± 0.46 vs 2.11 ± 0.96 g / dl, p = 0.011). The levels of thrombomodulin in serum increased, within the limit of statistical significance (10100.32 ± 6537.79 vs 7123.76 ± 3872.74 (pg / ml) ∙ 10, p = 0.087) while strong, significant correlations of thrombomodulin levels on patients admission by the APACHE SCORE ( r = 0.696, p = 0.017), the admission the SOFA SCORE (r = 0.932, p <0.0001) and albumin levels (negative correlation, r = -0.547, p = 0.08) was found.At the time of deterioration thrombomodulin levels had a strong association with the corresponding SOFA (r = 0.853, p = 0.001) and base deficit (negative correlation, r = -0.709, p = 0.022).
CONCLUSIONS
Thrombomodulin levels increase at the time of deterioration hemodynamic instability and organ failure and systems in critically ill septic patients while showing strong correlations with the severity scores.
Keywords:
Thrombomodulin,Haemostasis,SOFA score, Apache score
