title: Systemic neuropeptide levels as predictive indicators for lethal outcome in patients with postoperative sepsis.
abstract: OBJECTIVE
  To document changes in serum levels of the vasoactive and immunoregulatory neuropeptides, calcitonin gene-related peptide (CGRP) and substance P, in human postoperative sepsis and to determine whether levels correlate with outcome.
  
  
  METHODS
  Prospective, descriptive cohort study with no interventions.
  
  
  METHODS
  Surgical intensive care unit and clinical research center.
  
  
  METHODS
  The study included 61 patients with sepsis after major visceral surgery (survivors, n = 37; nonsurvivors, n = 24) and 23 control patients without sepsis.
  
  
  RESULTS
  Serum levels of CGRP and substance P were measured by specific enzyme-linked immunoassays over the course of sepsis. Postoperative sepsis was associated with a significant increase in CGRP serum levels. Systemic CGRP levels were significantly higher in nonsurvivors than in survivors as early as day 1 of sepsis and remained significantly elevated in nonsurvivors throughout the entire course of sepsis. Substance P levels were also elevated in sepsis patients as compared with controls, but significant differences between survivors and nonsurvivors were only observed during the final phase of sepsis.
  
  
  CONCLUSIONS
  High systemic CGRP levels were associated with lethal outcome already at the onset of sepsis, whereas high substance P levels were identified as late predictive indicators of lethal outcome. These results are consistent with the view that the neuropeptides, CGRP and substance P, may be involved in the pathogenesis of sepsis.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität, Munich, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Beer
authors.forename: Heike
authors.initials: H
authors.lastname: Weighardt
authors.forename: Klaus
authors.initials: K
authors.lastname: Emmanuilidis
authors.forename: Marit D
authors.initials: MD
authors.lastname: Harzenetter
authors.forename: Edouard
authors.initials: E
authors.lastname: Matevossian
authors.forename: Claus-Dieter
authors.initials: CD
authors.lastname: Heidecke
authors.forename: Holger
authors.initials: H
authors.lastname: Bartels
authors.forename: Jörg-Rüdiger
authors.initials: JR
authors.lastname: Siewert
authors.forename: Bernhard
authors.initials: B
authors.lastname: Holzmann
mesh_terms: D000368:Aged; D015740:Calcitonin Gene-Related Peptide / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009479:Neuropeptides / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000401:mortality; D013223:Statistics as Topic; D013373:Substance P / Q000097:blood; D013530:Surgical Wound Infection / Q000097:blood* / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009479:Neuropeptides; D013373:Substance P; D015740:Calcitonin Gene-Related Peptide