Vascular endothelial growth factor in severe sepsis and septic shock.
BACKGROUND
Vascular endothelial growth factor (VEGF) levels have been shown to be elevated in severe sepsis. We investigated the value of VEGF in predicting organ dysfunction and hospital mortality in adult patients with severe sepsis.


METHODS
We conducted a prospective observational cohort study in 24 closed multidisciplinary intensive care units (ICU) in Finland. All ICU admission episodes (4500) were screened for severe sepsis from November 1, 2004, to February 28, 2005. Patients were eligible if they fulfilled the criteria for severe sepsis.


RESULTS
Severe sepsis was found in 470 patients. Laboratory samples were obtained after informed consent from 250 patients at study entry (day 0) and from 215 patients after 72 h. These samples were compared with samples from 30 healthy individuals. The ICU mortality was 13.2% and hospital mortality 26%. Median serum VEGF concentrations on day 0 were 423 pg/mL (interquartile range [IQR] 159 and 858 pg/mL), and after 72 h were 521 pg/mL (IQR 182 and 1092 pg/mL), which were both higher than in healthy controls (P = 0.029 and 0.003, respectively). Low VEGF concentrations were associated with more severe renal and hematological dysfunction (Sequential Organ Failure Assessment scores 3-4 compared with scores 0-2). VEGF concentrations in day 0 and after 72 h were lower in nonsurvivors (P = 0.01 and <0.01, respectively) than in survivors, but the receiver operating characteristic curve analyses of concentrations of VEGF on day 0 and at 72 h revealed areas under the curve of 0.58 and 0.63 (95% confidence limits 0.48-0.68 and 0.54-0.72, P = 0.1 and 0.009, respectively).


CONCLUSIONS
VEGF concentrations are increased in patients with severe sepsis. Low concentrations are associated with hematological and renal dysfunction. VEGF concentrations were lower in nonsurvivors than in survivors, but did not adequately predict hospital mortality in patients with severe sepsis.
Karlsson
Sari
S
Department of Intensive Care Medicine, Tampere University Hospital, Finland. sari.karlsson@pshp.fi
Pettilä
Ville
V
Tenhunen
Jyrki
J
Lund
Vesa
V
Hovilehto
Seppo
S
Ruokonen
Esko
E
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005387:Finland / Q000453:epidemiology; D006402:Hematologic Diseases / Q000097:blood; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D051437:Renal Insufficiency / Q000097:blood; D018805:Sepsis / Q000097:blood* / Q000401:mortality; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
D015415:Biomarkers; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A