Endocrine and Metabolic Alterations May Underlie Mortality of Severe Sepsis and Septic Shock Patients Admitted to ICU

Abstract

The study evaluated endocrinal and metabolic response to sepsis and its applicability for the prediction of outcome of septic patients. Patients were 39 adult with severe infections and within 24 h after onset of suspected clinical tissue hypoperfusion. At enrollment patients were evaluated for acute physiology and chronic health evaluation II score (APACHE II) and Glasgow Coma Scale (GCS). Global hemodynamic parameters including systolic blood pressure (SBP), heart rate (HR) and central venous pressure (CVP) were recorded and monitored. All patients were managed at ICU due to Surviving Sepsis Campaign guidelines. ELISA estimated serum copeptin, macrophage migration inhibitory factor (MIF) and total cortisol (TC) and blood la ctate levels. Study outcome was survival rate via 28 days (28-D SR) and best predictor for it. The results showed that 22 patients passed total hospital stay uneventfully for a total survival rate of 56.4%. Seventeen patients died; 10 during ICU stay and 7 during word stay. At admission serum markers levels were significantly higher in survivors and nonsurvivors compared to controls and in non-survivors compared to survivors. Survival showed negative significant correlation with age, high blood lactate and serum copeptin, TC and MIF levels. Survival showed positive significant correlation with SBP, CVP and urine output. ROC curve and Regression analyses defined high at admission serum copeptin and blood lactate levels as significant predictors for mortality of septic patients.

Association of copeptin levels with patient prognosis and survival in sepsis syndromes: a meta-analysis

“…Numerous studies 28 , 29 , 35 , 39 , 40 have also found that the copeptin levels are significantly elevated during septicemia and increase proportionally with sepsis progression and severity. Likewise, studies have also reported lower admission copeptin levels in sepsis patients who survived 27 , 30 , 35 and these findings are similar to the findings that this meta-analysis produced. In contrast, the findings of Battista et al .…”

“…The detailed descriptive characteristics of the included studies are shown in Table 1 . Briefly, 15 studies were included in this meta-analysis 21 , 27 – 40 . The studies were conducted in different geographical locations: North America, Europe, and Asia.…”

Thyroid hormones as potential prognostic factors in sepsis

“…decreased baseline T3 and fT4 levels were associated with mortality. There are also other reports that, similarly to ours, documented a correlation between hypothyroxinaemia and mortality in sepsis and/or ICU mortality [14][15][16]. Moreover, a study by Meyer et al [17] suggested a relationship between T3 and fT4 serum level and mortality rate on the last day of hospitalisation; however, thyroid hormone levels measured on admission did not differ between survivors and non-survivors.…”

Prediction of Outcome of Sepsis at Surgical ICU: A Prospective Multi-Center Prospective Study

“…In line with these data, Jiang et al [31] found plasma Cp, CRP and PCT concentrations were positively correlated with APACHE II score in patients with sepsis, and reflected disease severity, while Ameen et al [32] reported that at admission serum Cp and blood lactate levels are significant predictors for mortality of septic patients. Also, Huang et al [33] documented that APACHE II scores and the levels of serum calprotectin and PCT on postoperative day-1 were the variables significantly associated with sepsis and its severity.…”