title: The impairment of small nerve fibers in severe sepsis and septic shock.
abstract: BACKGROUND
  A decrease of small nerve fibers in skin biopsies during the course of critical illness has been demonstrated recently. However, the diagnostic use of skin biopsies in sepsis and its time course is not known.
  
  
  METHODS
  Patients (n=32) with severe sepsis or septic shock were examined using skin biopsies, neurological examination, nerve conduction studies, and sympathetic skin response in the first week after onset of sepsis, 2 weeks and 4 months later and compared to gender- and age-matched healthy controls.
  
  
  RESULTS
  Skin biopsies at the ankle and thigh revealed a significant decrease of intraepidermal nerve fiber density (IENFD) during the first week of sepsis and 2 weeks later. All patients developed critical illness polyneuropathy (CIP) according to electrophysiological criteria and 11 showed IENFD values lower than the 0.05 quantile. Four patients were biopsied after 4 months and still showed decreased IENFD. Results of nerve conduction studies and IENFD did considerably change over time. No differences for survival time between patients with IEFND lower and larger than 3.5 fibers/mm were found.
  
  
  CONCLUSIONS
  Skin biopsy is able to detect an impairment of small sensory nerve fibers early in the course of sepsis. However, it may not be suited as a prognostic parameter for survival.
  
  
  BACKGROUND
  German Clinical Trials Register, DRKS-ID: DRKS00000642, 12/17/2010.
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, D-07747, Jena, Germany. hubertus.axer@med.uni-jena.de.
authors.forename: Hubertus
authors.identifier: http://orcid.org/0000-0002-3191-2796
authors.initials: H
authors.lastname: Axer
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, D-07747, Jena, Germany.|Department of Neurology and Epileptology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Grimm
authors.affiliation: Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.|Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University Leipzig, Leipzig, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Pausch
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, D-07747, Jena, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Teschner
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, D-07747, Jena, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Zinke
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, D-07747, Jena, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Eisenach
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, D-07747, Jena, Germany.
authors.forename: Sindy
authors.initials: S
authors.lastname: Beck
authors.affiliation: Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
authors.forename: Orlando
authors.initials: O
authors.lastname: Guntinas-Lichius
authors.affiliation: Center for Clinical Studies, Jena University Hospital, Jena, Germany.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Brunkhorst
authors.affiliation: Hans Berger Department of Neurology, Jena University Hospital, Erlanger Allee 101, D-07747, Jena, Germany.
authors.forename: Otto W
authors.initials: OW
authors.lastname: Witte
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009431:Neural Conduction / Q000502:physiology; D009460:Neurologic Examination / Q000379:methods; D011379:Prognosis; D018805:Sepsis / Q000150:complications* / Q000473:pathology; D012772:Shock, Septic / Q000150:complications* / Q000473:pathology; D012867:Skin / Q000098:blood supply / Q000293:injuries
keywords: Critical illness polyneuropathy; Sepsis; Skin biopsy; Small nerve fiber neuropathy