Dissertation committee:
Παγώνα Λάγιου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σεραφείμ Νανάς, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Κόλλιας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αναστασία Κοτανίδου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννα-Μαρία Δημοπούλου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Στυλιανός Ορφανός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νικολέτα Ροβίνα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction. Sepsis is common in ΙCU patients and despite significant progress in the investigation of sepsis mechanisms, mortality due to sepsis remains high.
Aim. Evaluation of prognostic accuracy of lactate, E and P selectins levels in patients at ICU admission and examination of baseline 25-hydroxyvitamin D levels in association with outcome.
Material and Methods. In this study, 227 initially non-septic critically ill patients were enrolled in the ICU, of whom 145 developed sepsis during ICU stay. To calculate the prognostic accuracy of biomarkers in development of sepsis (lactate, E and P selectin), ROC curves were applied. A group of 192 healthy subjects was used to compare vitamin D levels with those of the critically ill patients.
Results. Lactate levels combined with sE- and sPselectin levels have the best prognostic accuracy showing a sensitivity and specificity of 76% and 84%, respectively, and an area under the curve (AUC) at 0.854 (95% confidence interval (CI)=0.775-0.932; p<0.001). ICU admission 25-hydroxyvitamin D levels of critically-ill patients were much lower than those of healthy subjects (p< 0.0001). The median time to sepsis for the two patient groups did not differ, nor did the length of ICU stay. Both groups showed similar hospital mortality rates. Among patients who eventually became septic (N=145) there was an increased risk of respiratory infections in patients with vitamin D levels <7 ng / ml (p = 0.007).
Conclusion In our patient cohort, combining sE- and sP-selectin with serum lactate offers better prognostic value for sepsis development during ICU hospitalization. Low vitamin D levels (<7 ng/ml) at ICU admission do not predict sepsis development, increased risk of in-hospital mortality or longer stay in the ICU. However, patients with low admission vitamin D levels who will eventually develop sepsis are associated with development of respiratory tract infections.
Keywords:
Prognosis, Lactate, Selectins, Vitamin D, Sepsis
