Serum caspase 3 levels are associated with early mortality in severe septic patients.
Higher caspase 3 activity has been found in lymphocytes of septic patients than of healthy controls. However, an association between serum caspase 3 levels at moment of severe sepsis diagnosis and mortality in septic patients has not been previously demonstrated, and this was the main objective of the present study.



This is an observational study of 216 patients with severe sepsis in 6 Spanish intensive care units. We collected serum samples at moment of severe sepsis diagnosis to determine levels of caspase 3 and caspase-cleaved cytokeratin (CCCK) 18. End point was 30-day mortality.



We found higher serum caspase 3 levels (P<.001) and caspase-cleaved cytokeratin 18 (P=.001) in nonsurvivors (n=76) than in survivors (n=140). Multiple binary logistic regression analysis showed that serum caspase 3 levels greater than 0.25 ng/mL were associated with 30-day mortality (odds ratio, 6.51; 95% confidence interval, 3.32-12.77; P<.001). Receiver operating characteristic analysis showed that the area under the curve to predict 30-day mortality for serum caspase 3 levels was 0.73 (95% confidence interval, 0.67-0.79; P<.001).



The major novel findings of our study were that there is an association between serum caspase 3 levels at moment of severe sepsis diagnosis and mortality in septic patients and that serum caspase 3 levels could be used as prognostic biomarker, and further studies are needed to corroborate these findings.
Intensive Care Unit, Hospital Universitario de Canarias, Ofra, s/n. La Laguna, 38320, Tenerife, Spain. Electronic address: lorentemartin@msn.com.
Leonardo
L
Lorente
Intensive Care Unit, Hospital Universitario Nuestra Señora Candelaria, Crta Rosario s/n. Santa Cruz, Tenerife, 38010, Spain. Electronic address: mar.martinvelasco@gmail.com.
María M
MM
Martín
Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez n°17-19, Valencia, 46004, Spain. Electronic address: ferreresj@gmail.com.
José
J
Ferreres
Intensive Care Unit, Hospital Universitario, Dr. Negrín. Barranco de la Ballena s/n., Las Palmas de Gran Canaria, 35010, Spain. Electronic address: jsolvio@gobiernodecanarias.org.
Jordi
J
Solé-Violán
Intensive Care Unit, Hospital San Jorge de Huesca, Huesca 22004, Spain. Electronic address: llabarta@salud.aragon.es.
Lorenzo
L
Labarta
Intensive Care Unit, Hospital Insular, Las Palmas de Gran Canaria 35016, Spain. Electronic address: incaicos@yahoo.es.
César
C
Díaz
Research Unit, Hospital Universitario de Canarias, 38320 Tenerife, Spain. Electronic address: ajimenezsosa@gmail.com.
Alejandro
A
Jiménez
Laboratory Department, Hospital Universitario de Canarias, 38320 Tenerife, Spain. Electronic address: jmborreguero@hotmail.com.
Juan M
JM
Borreguero-León
D000368:Aged; D015415:Biomarkers / Q000097:blood; D053148:Caspase 3 / Q000097:blood*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053538:Keratin-18 / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000401:mortality; D013030:Spain; D017741:Survivors
D015415:Biomarkers; C488421:KRT18 protein, human; D053538:Keratin-18; C505407:CASP3 protein, human; D053148:Caspase 3
Caspase-3; Mortality; Outcome; Sepsis