title: Skin collagen synthesis is depressed in patients with severe sepsis.
abstract: BACKGROUND
  Skin is an essential barrier in maintaining a stable internal environment. Adequate regenerative capacity is crucial to overcome the homeostatic challenges caused by a septic insult. In sepsis, coagulation and inflammation are activated to restore homeostasis, but it is not known whether sepsis also alters tissue regeneration processes such as skin collagen synthesis.
  
  
  METHODS
  In this prospective observational study, we measured aminoterminal propeptides of collagens I and III (PINP, PIIINP) from blister fluid of sepsis patients. Blister fluid was obtained from experimental blisters induced on intact abdominal skin 4 times: within the first 48 hours from the first organ failure, on the fifth day, and at 3 and 6 months thereafter. Forty-four patients with severe sepsis were enrolled. The median age was 63 years (25th-75th percentile, 53-71 years). The median Acute Physiology and Chronic Health Evaluation II score on admission was 26 (22-30). Thirty-day mortality was 25%. Fifteen healthy adults were used as controls.
  
  
  RESULTS
  Median PIIINP and PINP levels in septic patients were lower in comparison with controls in the first blister (40.8 microg/L [25th-75th percentile, 22.2-77.1 microg/L], P = 0.028 and 69.9 microg/L [32.4-112.7 microg/L], P < 0.001, respectively) and in the blister induced on day 5 (38.8 microg/L [19.9-68.5 microg/L], P < 0.001 and 90.0 [35.1-138.8 microg/L], P < 0.001, respectively). The survivors revealed an overexpression at 3 months, whereas normal values of PIIINP and PINP were reestablished at 6 months.
  
  
  CONCLUSIONS
  Skin collagen synthesis is depressed during severe sepsis and is followed by a compensatory response 3 and 6 months after the onset of sepsis.
authors.affiliation: Department of Anaesthesiology, Division of Intensive Care, Oulu University Hospital, P.O. Box 21, FI-90029 Oulu, Finland. fpeltola@mail.student.oulu.fi
authors.forename: Fiia P
authors.initials: FP
authors.lastname: Gäddnäs
authors.forename: Marjo
authors.initials: M
authors.lastname: Koskela
authors.forename: Vesa
authors.initials: V
authors.lastname: Koivukangas
authors.forename: Jouko
authors.initials: J
authors.lastname: Laurila
authors.forename: Juha
authors.initials: J
authors.lastname: Saarnio
authors.forename: Juha
authors.initials: J
authors.lastname: Risteli
authors.forename: Aarne
authors.initials: A
authors.lastname: Oikarinen
authors.forename: Tero
authors.initials: T
authors.lastname: Ala-Kokko
mesh_terms: D000368:Aged; D003094:Collagen / Q000096:biosynthesis*; D024042:Collagen Type I / Q000378:metabolism; D024061:Collagen Type III / Q000378:metabolism; D003422:Critical Care; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011347:Procollagen / Q000096:biosynthesis; D011446:Prospective Studies; D018805:Sepsis / Q000378:metabolism*; D012867:Skin / Q000378:metabolism*; D013048:Specimen Handling; D016896:Treatment Outcome
chemical_list: D024042:Collagen Type I; D024061:Collagen Type III; D011347:Procollagen; D019344:Lactic Acid; D003094:Collagen