Pronounced elevation of resistin correlates with severity of disease in severe sepsis and septic shock.
OBJECTIVE
Resistin induces insulin resistance in mice. In humans, recent data suggest that resistin functions as a proinflammatory cytokine. Here, we studied resistin up to 2 wks after admission in patients with septic shock and/or severe sepsis.


METHODS
Two prospective studies of patients with sepsis and in vitro studies of resistin interaction with monocytes.


METHODS
Intensive care unit at Karolinska University Hospital and Center for Infectious Medicine, Karolinska Institute, Huddinge, Sweden.


METHODS
Twenty-nine patients with severe sepsis and 66 with septic shock.


METHODS
None.


RESULTS
Ninety-five patients were studied, 25 of whom died within 28 days. Resistin and cytokine levels and routine biochemistry were measured at three to six defined time points during the first 2 wks after admission and were correlated to other cytokines, glucose levels, body mass index, Acute Physiology and Chronic Health Evaluation II, and Sepsis-related Organ Failure Assessment scores. Serum resistin was significantly elevated compared with healthy controls (p < .000001) and correlated with severity of disease as measured by Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment scores, with an increasingly strong degree of correlation over time. Median levels were four- to eight-fold higher than controls and remained high up to 2 wks after admission to the intensive care unit. Levels correlated with interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-alpha, creatinine, D-dimer, and lactate, but not with p-glucose or body mass index. In vitro, resistin was released from monocytes after stimulation with either lipopolysaccharide or high mobility group box 1 protein. Recombinant resistin itself up-regulated intercellular adhesion molecule-1 on monocytes.


CONCLUSIONS
This is the first study assessing systemic levels of resistin in patients with septic shock/severe sepsis. We show that resistin is a marker of severity of disease and possibly a mediator of the prolonged inflammatory state seen in infected critically ill patients. Further exploration of resistin as a therapeutic target and marker of disease is merited.
Sundén-Cullberg
Jonas
J
Department of Medicine, Division of Infectious Diseases, Center for Infectious Medicine, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden. jonas.sunden-cullberg@ki.se
Nyström
Thomas
T
Lee
Martin L
ML
Mullins
Gail E
GE
Tokics
Leif
L
Andersson
Jan
J
Norrby-Teglund
Anna
A
Treutiger
Carl Johan
CJ
D018806:APACHE; D016470:Bacteremia / Q000097:blood / Q000378:metabolism; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001786:Blood Glucose; D015992:Body Mass Index; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism; D011446:Prospective Studies; D052243:Resistin / Q000096:biosynthesis*; D018805:Sepsis / Q000097:blood / Q000378:metabolism*; D012772:Shock, Septic / Q000097:blood / Q000378:metabolism
D015415:Biomarkers; D001786:Blood Glucose; D016207:Cytokines; D052243:Resistin