Endocan is useful biomarker of survival and severity in sepsis.
BACKGROUND
Coagulation abnormalities which occur as a consequence of endothelial changes are recognized as diagnostic criteria for sepsis, but significance of these changes in the outcome prognosis and prediction of the course of sepsis is still not accurately defined.


METHODS
60 patients who fulfilled the criteria for diagnosis of sepsis were included in our study. Patients were categorized in two groups according to sepsis severity and organ failure and MODS development was assessed in the first 48 h from ICU admission. Prothrombin time (PT), activated partial thromboplastin time (aPTT) and endothelial cell specific molecule-1(endocan) levels, as well as procalcitonin (PCT) and C-reactive protein (CRP) were determined within the first 24h of the onset of the disease. Predictive APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores were calculated on the day of ICU admission. Data were used to determine an association between day 1 biomarker levels, organ dysfunction score values and the development of organ failure, multiple organ dysfunction syndrome (MODS), and mortality during 28 days. These connections were determined by plotting of receiver operating characteristic (ROC) curves. Differences between groups were assessed by Mann-Whitney U test. Categorical variables were compared using chi-square test.


RESULTS
Concentration of endocan was significantly higher in the group of patients with sepsis induced organ failure, MODS development and in the group of non- survivors in contrast to group with less severe form of the disease, without multiorgan failure, and in contrast to group of survivors (p<0.05). Values of areas under the ROC curves showed that endocan levels had good discriminative power for more severe course of sepsis, MODS development and possible discriminative power for mortality prediction (AUC: 0.81, 0.67, 0.71 retrospectively), better than PCT for fatality (AUC:053) and better than APACHE II (AUC:0.55) and SOFA (AUC: 0.57) scores for organ failure.


CONCLUSIONS
Results of our study show that endocan can be used as strong and significant predictor of sepsis severity and outcome, perhaps even better than SOFA and APACHE II scores.
Clinical Centre of Vojvodina, Emergency Centre, Department of Anesthesia and Reanimation, Novi Sad, Serbia. Electronic address: dunjamihajlovic@hotmail.com.
Dunja M
DM
Mihajlovic
Clinical Centre of Vojvodina, Clinic for Infectious Diseases-Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
Dajana F
DF
Lendak
Clinical Centre of Vojvodina, Clinic for Infectious Diseases-Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
Snezana V
SV
Brkic
Institute of Child and Adolescent Health Care of Vojvodina, Clinic of Pediatric Surgery-Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
Biljana G
BG
Draskovic
Clinical Centre of Vojvodina, Laboratory Medicine Centre, Department of Hematology, Hemostasis, and Prevention of Thrombosis-Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
Gorana P
GP
Mitic
Clinical Centre of Vojvodina, Clinic of Gynecology and Obstetrics-Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
Aleksandra S
AS
Novakov Mikic
Medical Faculty, University of Novi Sad, Department of biochemistry, Novi Sad, Serbia.
Tatjana N
TN
Cebovic
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology / Q000401:mortality; D009363:Neoplasm Proteins / Q000097:blood*; D063305:Organ Dysfunction Scores; D010314:Partial Thromboplastin Time; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011509:Proteoglycans / Q000097:blood*; D011517:Prothrombin Time; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D012720:Severity of Illness Index; D015854:Up-Regulation
D015415:Biomarkers; C000606589:CALCA protein, human; C101134:ESM1 protein, human; D009363:Neoplasm Proteins; D011498:Protein Precursors; D011509:Proteoglycans; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
APACHE; Coagulation; Endocan; Endothelium; Hemostasis; Infection; MODS; Prognosis; Sepsis; Shock