title: Biomarkers in sepsis at time zero: intensive care unit scores, plasma measurements and polymorphisms in Argentina.
abstract: BACKGROUND
  A patient's response to sepsis is influenced by their genetic background. Our objective was to use plasma markers, such as protein C (PC), D-dimer, Plasminogen Activator Inhibitor-1 (PAI-1) levels, and the PAI-1 rs1799889 4G/5G and  Tumor Necrosis Factor-α rs1800629 G/A  polymorphisms to improve classical intensive care unit (ICU) scores.
  
  
  METHODS
  We studied 380 subjects, 166 with sepsis. We performed coagulation tests: plasma PAI-1 and PC levels were evaluated by chromogenic methods; and D-dimer was evaluated by immunoturbidimetric assay. Polymorphisms were performed using for polymerase chain reactions followed by digest with specific restriction enzyme. We acquired the APACHE and SOFA scores (time zero), sex, age, body mass index, associated co-morbidities, length of ICU stay (days), the severity of sepsis (sepsis, severe sepsis or septic shock), the HIV status and the ICU outcome (survival or death).
  
  
  RESULTS
  We found significant differences between patients who died (n=80) and those who survived (n=86) in terms of the ICU length of stay (6 vs. 10 days), septic shock (64 versus 24%), age (51 versus 38 years old), HIV+ condition (34 versus 16%), SOFA (7 versus 4), APACHE (19 versus 13), D-dimer (4.32 versus 2.88 mg/ml), PC (46.0 versus 63.5 %) and PAI-1 (33.0 versus 16.5 UA/l). When we used a regression analysis with dichotomized variables, only the SOFA4, PAI-116, HIV status and the PAI-1 4G allele proved to be predictors of death at time zero.
  
  
  CONCLUSIONS
  In the future, ICU scores may be further improved by adding certain genomic or plasma data.
authors: Hospital of Infectious Diseases F. J. Muñiz, Buenos Aires, Argentina. sdaperes@yahoo.com.ar
authors: Silvia Daniela Amanda
authors: SD
authors: Perés Wingeyer
authors: Eleonora Roxana
authors: ER
authors: Cunto
authors: Cristina Mabel
authors: CM
authors: Nogueras
authors: Jorge Alejandro
authors: JA
authors: San Juan
authors: Norberto
authors: N
authors: Gomez
authors: Gabriela Fernanda
authors: GF
authors: de Larrañaga
mesh_terms: D018806:APACHE; D000328:Adult; D001118:Argentina; D015415:Biomarkers / Q000097:blood*; D019411:Clinical Laboratory Techniques; D015510:Clinical Medicine / Q000379:methods; D020022:Genetic Predisposition to Disease; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry*; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics*; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D012150:Polymorphism, Restriction Fragment Length; D018805:Sepsis / Q000175:diagnosis* / Q000235:genetics*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics*
chemical_list: D015415:Biomarkers; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D014409:Tumor Necrosis Factor-alpha