title: Pentraxin 3 in patients with severe sepsis or shock: the ALBIOS trial.
abstract: BACKGROUND
  The long pentraxin PTX3 is a key component of the humoral arm of innate immunity related to sepsis severity and mortality. We evaluated the clinical and prognostic significance of circulating PTX3 in the largest cohort ever reported of patients with severe sepsis or septic shock.
  
  
  METHODS
  Plasma PTX3 was measured on days 1, 2 and 7 after randomization of 958 patients to albumin or crystalloids for fluid resuscitation in the multicentre Albumin Italian Outcome Sepsis (ALBIOS) trial. We tested the association of PTX3 and its changes over time with clinical severity, prevalent and incident organ dysfunctions, 90-day mortality and treatment.
  
  
  RESULTS
  PTX3 was high at baseline (72 [33-186] ng/mL) and rose with the severity and number of organ dysfunctions (P < 0·001) and the incidence of subsequent new failures. The PTX3 concentration dropped from day 1 to 7, but this decrease was less pronounced in patients with septic shock (P = 0·0004). Higher concentrations of PTX3 on day 1 predicted incident organ dysfunctions. Albumin supplementation was associated with lower levels of PTX3 in patients with septic shock (P = 0·005) but not in those without shock. In a fully adjusted multivariable model, PTX3 on day 7 predicted 90-day mortality. Smaller drops in PTX3 predicted higher 90-day mortality.
  
  
  CONCLUSIONS
  In severe sepsis and septic shock, early high PTX3 predict subsequent new organ failures, while a smaller drop in circulating PTX3 over time predicts an increased risk of death. Patients with septic shock show lower levels of PTX3 when assigned to albumin than to crystalloids.
authors.affiliation: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.|Dipartimento di Anestesia, Rianimazione, ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caironi
authors.affiliation: Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.affiliation: Dipartimento di Anestesia, Rianimazione, ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Mauri
authors.affiliation: Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bottazzi
authors.affiliation: Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Leone
authors.affiliation: Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Magnoli
authors.affiliation: Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Barlera
authors.affiliation: ASST Bergamo Est, Seriate, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Mamprin
authors.affiliation: Azienda Ospedaliera Universitaria "San Martino", Genova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fedele
authors.affiliation: Humanitas Clinical and Research Center, Rozzano, Milan, Italy.|Humanitas University, Istituto Clinico Humanitas, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mantovani
authors.affiliation: Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.affiliation: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.|Dipartimento di Anestesia, Rianimazione, ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.affiliation: Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D007558:Italy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000378:metabolism*; D015999:Multivariate Analysis; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000378:metabolism / Q000628:therapy; D000683:Serum Amyloid P-Component / Q000378:metabolism*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000378:metabolism* / Q000628:therapy; D000099153:Pentraxins
chemical_list: D000418:Albumins; D015415:Biomarkers; D002097:C-Reactive Protein; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D000683:Serum Amyloid P-Component; D000099153:Pentraxins
keywords: Albumin; pentraxin 3; prognosis; septic shock; severe sepsis