title: Vascular endothelial growth factor and soluble fms-like tyrosine kinase-1 in septic shock patients treated with direct hemoperfusion with a polymyxin B-immobilized fiber column.
abstract: Sepsis is characterized by a systemic inflammatory response to a microbial pathogen. In sepsis, capillary permeability is a tightly regulated feature of microcirculation in all organ beds and is fundamentally altered. We investigated the vascular endothelial growth factor (VEGF) level as a vascular permeability factor and the soluble fms-like tyrosine kinase-1 (Flt-1) level as an antagonist of the VEGF receptors. Serum VEGF and soluble Flt-1 levels in 21 patients with septic shock, who were treated with direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX), were measured by enzyme-linked immunoassay. The VEGF and the soluble Flt-1 levels were more elevated in patients with septic shock than in controls. Between 14 survivors and 7 non-survivors, there was no significant difference in VEGF level before the DHP-PMX therapy, but the soluble Flt-1 level of survivors was significantly lower than that of non-survivors. Although there was no significant difference between starting and ending VEGF levels in survivors, in non-survivors the VEGF level at the end of DHP-PMX therapy was significantly lower than that at the start. In survivors, the soluble Flt-1 level at the end of DHP-PMX therapy was significantly lower than that at the start. On the other hand, in non-survivors, there was no significant difference between the ending and starting soluble Flt-1 levels. The soluble Flt-1 level may be a suitable marker of disease severity and mortality.
authors.affiliation: Department of Nephrology, Mito Saiseikai General Hospital, Mito, Japan. itaruebi@yahoo.co.jp
authors.forename: Itaru
authors.initials: I
authors.lastname: Ebihara
authors.forename: Kouichi
authors.initials: K
authors.lastname: Hirayama
authors.forename: Shuzo
authors.initials: S
authors.lastname: Kaneko
authors.forename: Miho
authors.initials: M
authors.lastname: Nagai
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Shogo
authors.initials: S
authors.lastname: Fujita
authors.forename: Joichi
authors.initials: J
authors.lastname: Usui
authors.forename: Kaori
authors.initials: K
authors.lastname: Mase
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yamagata
authors.forename: Masaki
authors.initials: M
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015415:Biomarkers / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000008:administration & dosage*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000378:metabolism / Q000401:mortality / Q000628:therapy*; D017741:Survivors; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D042461:Vascular Endothelial Growth Factor A; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1; D011112:Polymyxin B