title: Soluble RAGE as a severity marker in community acquired pneumonia associated sepsis.
abstract: BACKGROUND
  Community-acquired pneumonia (CAP) is considered the most important cause of death from infectious disease in developed countries. Severity assessment scores partially address the difficulties in identifying high-risk patients. A lack of specific and valid pathophysiologic severity markers affect early and effective sepsis therapy. HMGB-1, sRAGE and RAGE have been involved in sepsis and their potential as severity markers has been proposed. The aim of this study was to evaluate HMGB-1, RAGE and sRAGE levels in patients with CAP-associated sepsis and determine their possible association with clinical outcome.
  
  
  METHODS
  We evaluated 33 patients with CAP-associated sepsis admitted to the emergency room and followed in the medical wards. Severity assessment scores (CURB-65, PSI, APACHE II, SOFA) and serologic markers (HMGB-1, RAGE, sRAGE) were evaluated on admission.
  
  
  RESULTS
  Thirty patients with a diagnosis of CAP-associated sepsis were enrolled in the study within 24 hours after admission. Fourteen (46.6%) had pandemic (H1N1) influenza A virus, 2 (6.6%) had seasonal influenza A and 14 other diagnoses. Of the patients in the study group, 16 (53.3%) had a fatal outcome. ARDS was observed in 17 (56.6%) and a total of 22 patients had severe sepsis on admission (73%). The SOFA score showed the greatest difference between surviving and non-surviving groups (P = .003) with similar results in ARDS patients (P = .005). sRAGE levels tended to be higher in non-surviving (P = .058) and ARDS patients (P = .058). Logistic regression modeling demonstrated that SOFA (P = .013) and sRAGE (P = .05) were the only variables that modified the probability of a fatal outcome.
  
  
  CONCLUSIONS
  The association of elevated sRAGE with a fatal outcome suggests that it may have an independent causal effect in CAP. SOFA scores were the only clinical factor with the ability to identify surviving and ARDS patients.
authors.affiliation: Department of Immunology, Universidad Autonoma de Nuevo Leon, UANL, School of Medicine and University Hospital, Monterrey Nuevo Leon, Mexico.
authors.forename: Rodrigo M
authors.initials: RM
authors.lastname: Narvaez-Rivera
authors.forename: Adrian
authors.initials: A
authors.lastname: Rendon
authors.forename: Mario C
authors.initials: MC
authors.lastname: Salinas-Carmona
authors.forename: Adrian G
authors.initials: AG
authors.lastname: Rosas-Taraco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D009980:Influenza A virus; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D000067759:Receptor for Advanced Glycation End Products / Q000097:blood*; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D000067759:Receptor for Advanced Glycation End Products