title: The Lectin Complement Pathway in Patients with Necrotizing Soft Tissue Infection.
abstract: Mannose-binding lectin (MBL) and ficolins are pattern recognition molecules (PRMs) that play an important role during infection through activation of the lectin complement pathway. We assessed whether plasma PRM levels were associated with mortality in patients with necrotizing soft tissue infection (NSTI).
  
  
  
  We conducted a prospective, observational study over 25 months involving 135 NSTI patients with a maximum follow-up of 2.7 years. Blood samples were taken upon admission. Non-infected patients served as controls.
  
  
  
  PRM levels were significantly lower compared with controls. A baseline Ficolin-2 level below the median was associated with mortality at the end of follow-up (p = 0.007). No significant association was found for MBL, Ficolin-1 and Ficolin-3. A Ficolin-2 level below the median had a negative predictive value of 0.94 for 28-day mortality, and a level below the optimal cut-off was independently associated with 28-day mortality when adjusted for age, sex and chronicity [hazard ratio 6.27 (95% confidence interval 2.28-17.21), p < 0.0001], also when Simplified Acute Physiology Score II was included in the analysis [hazard ratio 3.16 (95% confidence interval 1.03-9.73), p = 0.045].
  
  
  
  All PRMs were significantly lower in patients with NSTI than in controls. Only baseline Ficolin-2 was associated with short- and long-term mortality. A high baseline Ficolin-2 level indicated a 94% chance of surviving the first 28 days after admission.
authors.affiliation: Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Marco B
authors.initials: MB
authors.lastname: Hansen
authors.forename: Lars S
authors.initials: LS
authors.lastname: Rasmussen
authors.forename: Katrine
authors.initials: K
authors.lastname: Pilely
authors.forename: Dorthe
authors.initials: D
authors.lastname: Hellemann
authors.forename: Estrid
authors.initials: E
authors.lastname: Hein
authors.forename: Martin B
authors.initials: MB
authors.lastname: Madsen
authors.forename: Ole
authors.initials: O
authors.lastname: Hyldegaard
authors.forename: Peter
authors.initials: P
authors.lastname: Garred
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D037582:Complement Pathway, Mannose-Binding Lectin; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D037102:Lectins / Q000097:blood*; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood*; D008875:Middle Aged; D009336:Necrosis; D011446:Prospective Studies; D051192:Receptors, Pattern Recognition / Q000097:blood*; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000276:immunology* / Q000401:mortality; D016019:Survival Analysis; D000097604:Ficolins
chemical_list: D015415:Biomarkers; D037102:Lectins; D037601:Mannose-Binding Lectin; D051192:Receptors, Pattern Recognition; D000097604:Ficolins