Dissertation committee:
Ηρακλής Τσαγκάρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Γιαμαρέλλος-Μπουρμπούλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Απόστολος Αρμαγανίδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Στυλιανός Ορφανός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεώργιος Δημόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Μισιακός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αντώνιος Παπαδόπουλος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Background: Available biomarkers do not still provide adequate diagnostic and prognostic performance for the critically ill; the need for development of new biomarkers remains mandatory. Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)raise interestfor sepsis diagnosis and prognosis.
Methods: Data from a cohort of 232 patients with gram negative sepsis (test cohort) and a second sepsis cohort of 104 patients with ventilator associated pneumonia, used as a validation cohort, were retrospectively analyzed. PlGF, s-Flt-1 and procalcitonin (PCT) were measured in serum within 24 hours from sepsis onset and were repeated on days 3 and 7.
Results: PCT and s-Flt-1 levels at baseline, on the contrary to PlGF, were higher in patients with sepsis and septic shock compared to those with infection.s-Flt-1 cutoff 64 pg/ml detected sepsis with sensitivity 68.1% and specificity 67.3%. S-Flt-1 higher than 91 pg/ml predicted unfavorable outcome with specificity 80.3% and after logistic regression was anindependent predictor of 28-day mortality.Decrease in serum PCT levels on day 7 higher than 80% from initial value and/or a valuelower than 0.5 ng/ml was the earliest sign independently protective from sepsis-associated death. The co-presence of s-Flt-1 levels lower than 73 pg/ml on day 7 added a synergistic protective effect to the developed PCT rule.
Conclusions: The present study underlines the importance of a combination of biomarkers in sepsis.S-Flt-1 and PCT seem promising for the diagnosis and prognosis of sepsis as well as for the treatment follow-up.
Keywords:
Sepsis, Infection, Septic shock, Biomarkers, Procalcitonin, SFlt1, PlGF, Bacteremia,PCT
