Prognostic value of malondialdehyde serum levels in severe sepsis: a multicenter study.
OBJECTIVE
The oxidant/antioxidant state in septic patients has only been studied in small series. We wished to determine whether malondialdehyde (MDA) serum levels were associated with severity and 30-day mortality in a large series of patients with sepsis.


METHODS
We performed an observational, prospective, multicenter study in six Spanish Intensive Care Units. Serum levels of MDA were measured in a total of 228 patients (145 survivors and 83 non-survivors) with severe sepsis and 100 healthy controls.


RESULTS
Serum levels of MDA were higher in severe septic patients than in healthy controls. Non-surviving septic patients had higher MDA values than survivors. MDA serum levels were associated with severity markers (lactic acid, SOFA, APACHE-II) and coagulation indices. Regression analysis showed that MDA serum levels were associated with 30-day survival (Hazard ratio = 1.05; 95% confidence interval = 1.009-1.091; p = 0.016). Receiver operating characteristic analysis showed that the area under curve of MDA serum levels to predict 30-day survival was 0.62 (95% CI = 0.56-0.69; P = 0.002). The risk of death in septic patients with MDA serum levels above 4.11 nmol/mL was higher than in patients with lower values (Hazard Ratio = 2.43; 95% CI = 1.49-3.94; p<0.001).


CONCLUSIONS
The novel findings of our study on severe septic patients, to our knowledge the largest series providing data on the oxidative state, are that elevated MDA serum levels probably represent an unbalanced oxidant state and are related with poor prognosis in patients with severe sepsis.
Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. lorentemartin@msn.com
Leonardo
L
Lorente
María M
MM
Martín
Pedro
P
Abreu-González
Alberto
A
Domínguez-Rodríguez
Lorenzo
L
Labarta
César
C
Díaz
Jordi
J
Solé-Violán
José
J
Ferreres
Juan María
JM
Borreguero-León
Alejandro
A
Jiménez
Armando
A
Morera-Fumero
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000097:blood*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis*
D015415:Biomarkers; D008315:Malondialdehyde