title: Levels of endothelial and platelet microparticles and their interactions with leukocytes negatively correlate with organ dysfunction and predict mortality in severe sepsis.
abstract: OBJECTIVE
  Mortality in sepsis is believed to be associated with exaggerated inflammatory responses, but recent evidence suggests that poor outcome is associated with reduced inflammation. To test this hypothesis, we measured several inflammatory markers to determine whether any of them or any combinations are associated with mortality or organ dysfunction.
  
  
  METHODS
  Clinical study.
  
  
  METHODS
  School of medicine.
  
  
  METHODS
  Thirty-five patients with severe sepsis.
  
  
  METHODS
  Markers of endothelial, platelet, and leukocyte activation were measured on days 1, 2, and 3 after enrollment. The markers were a) endothelial microparticles (EMPs) and their conjugates with monocytes (EMP/MONO); b) platelet microparticles (PMPs) and platelet activation marker CD62P; c) platelet-leukocyte conjugates (PLT/LEU) and leukocyte activation marker CD11b; and d) intracellular nitric oxide in leukocytes.
  
  
  RESULTS
  The 28-day mortality rate was 51% (18 of 35). Significant differences between survivors and nonsurvivors on day 1 were found in PLT/LEU (p = .001), CD11b (p = 0.02), and EMP/MONO (p = .02) groups. Using logistic regression to assess if these markers predict mortality on day 1, we found that PLT/LEU had the best predictive value among the markers used (area under receiver operating characteristics curve = 0.82). All markers of cell activation and inflammation were significantly higher among survivors on days 2 and 3, except nitric oxide, which was lower. This marker showed significant negative correlation with the Sequential Organ Failure Assessment score throughout the study.
  
  
  CONCLUSIONS
  Our data support the hypothesis that early increased, not decreased, inflammatory response as measured by our markers is associated with improved survival rate. A high negative correlation was found between some of these markers and Sequential Organ Failure Assessment score.
authors.affiliation: Wallace H. Coulter Platelet Laboratory, Division of Hematology/Oncology, University of Miami School of Medicine, Miami, FL 33136, USA.
authors.forename: Andres O
authors.initials: AO
authors.lastname: Soriano
authors.forename: Wenche
authors.initials: W
authors.lastname: Jy
authors.forename: Julio A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: Martin A
authors.initials: MA
authors.lastname: Valdivia
authors.forename: Hermes S
authors.initials: HS
authors.lastname: Velasquez
authors.forename: Joaquin J
authors.initials: JJ
authors.lastname: Jimenez
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Horstman
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kett
authors.forename: Roland M H
authors.initials: RM
authors.lastname: Schein
authors.forename: Yeon S
authors.initials: YS
authors.lastname: Ahn
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D015539:Platelet Activation; D011237:Predictive Value of Tests; D018805:Sepsis / Q000097:blood* / Q000401:mortality / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide