Persisting high levels of plasma pentraxin 3 over the first days after severe sepsis and septic shock onset are associated with mortality.
OBJECTIVE
Pentraxin 3 (PTX3) is an inflammatory mediator produced by neutrophils, macrophages, myeloid dendritic and endothelial cells. During sepsis a massive inflammatory activation and coagulation/fibrinolysis dysfunction occur. PTX3, as a mediator of inflammation, may represent an early marker of severity and outcome in sepsis.


METHODS
This study is based on a prospective trial regarding the impact of glycemic control on coagulation in sepsis. Ninety patients admitted to three general intensive care units were enrolled when severe sepsis or septic shock was diagnosed. At enrollment, we recorded sepsis signs, disease severity, coagulation activation [prothrombin fragments 1 + 2 (F(1+2))] and fibrinolysis inhibition [plasminogen activator inhibitor-1 (PAI-1)]. We measured plasma PTX3 levels at enrollment, everyday until day 7, then at days 9, 11, 13, 18, 23 and 28. Mortality was recorded at day 90.


RESULTS
Although not different on day 1, PTX3 remained significantly higher in non-survivors than in survivors over the first 5 days (p = 0.002 by general linear model). On day 1, PTX3 levels were higher in septic shock than in severely septic patients (p = 0.029). Day 1 PTX3 was significantly correlated with platelet count (p < 0.001), SAPS II score (p = 0.006) and SOFA score (p < 0.001). Day 1 PTX3 was correlated with F(1+2) concentration and with PAI-1 activity and concentration (p < 0.05 for all).


CONCLUSIONS
Persisting high levels of circulating PTX3 over the first days from sepsis onset may be associated with mortality. PTX3 correlates with severity of sepsis and with sepsis-associated coagulation/fibrinolysis dysfunction.
Mauri
Tommaso
T
Dipartimento di Medicina Perioperatoria e Terapie Intensive, Azienda Ospedaliera San Gerardo di Monza, Via Pergolesi 33, 20052, Monza, Italy.
Bellani
Giacomo
G
Patroniti
Nicolo'
N
Coppadoro
Andrea
A
Peri
Giuseppe
G
Cuccovillo
Ivan
I
Cugno
Massimo
M
Iapichino
Gaetano
G
Gattinoni
Luciano
L
Pesenti
Antonio
A
Mantovani
Alberto
A
D018806:APACHE; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001778:Blood Coagulation Disorders / Q000097:blood / Q000401:mortality; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000401:mortality*; D000683:Serum Amyloid P-Component / Q000378:metabolism*; D012772:Shock, Septic / Q000097:blood* / Q000401:mortality*; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D000099153:Pentraxins
D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D015850:Interleukin-6; D000683:Serum Amyloid P-Component; D014409:Tumor Necrosis Factor-alpha; D000099153:Pentraxins