Abstract
(1) Background: Sepsis still represents a major health care challenge, with mortality rates exceeding 25% in the western world. To further improve outcomes in this patient collective, new cardiovascular biomarkers present a promising opportunity as they target the paramount prognostic processes in sepsis: inflammation and ischemia. However, in contrast to cardiovascular diseases, a detailed analysis of novel biomarkers in sepsis is still lacking. (2) Objective: In this project, we aimed to perform a comparative analysis of biomarker levels in ischemic cardiovascular disease and sepsis. Analyzed markers comprised soluble suppression of tumorigenicity 2 (sST2; hemodynamics and inflammation), growth-differentiation factor 15 (GDF-15; injury, remodelling), soluble urokinase-type plasminogen activator receptor (suPAR; inflammation and remodeling) and heart-type fatty acid binding protein (H-FABP; myocardial ischemia). (3) Methods: In total, 311 patients were included in the study: 123 heart-failure (HF) patients, 60 patients with ST-segment elevation myocardial infarction (STEMI) and 53 sepsis patients. A total of 75 patients without coronary artery disease or signs of heart failure served as a control group. Plasma samples were analyzed by use of ELISA after informed consent. (4) Results: Patients with sepsis showed significantly increased plasma levels in all tested biomarkers compared to cardiovascular disease entities (sST2, suPAR, GDF-15: p < 0.001; H-FABP: compared to HF p < 0.001) and controls (sST2: 7.4-fold, suPAR: 3.4-fold, GDF-15: 6.5-fold and H-FABP: 15.3-fold increased plasma levels, p < 0.001). Moreover, in patients with sepsis, serum concentrations of sST2 and suPAR were significantly elevated in patients with HF and patients with STEMI (sST2: HF: 1.6-fold increase and STEMI: 2.5-fold increase, p < 0.001; suPAR: HF: 1.4-fold increase, p < 0.001 and STEMI: 1.4-fold increase, p < 0.01), whereas plasma levels of GDF-15 and H-FABP were markedly elevated in patients with STEMI only (GDF-15: 1.6-fold increase, H-FABP: 6.4-fold increase, p < 0.001). (5) Conclusions: All tested novel cardiac biomarkers showed significantly elevated levels in sepsis patients. Interestingly, a secretion pattern similar to STEMI was observed with regards to sST2 and HFABP. Thus, by providing an assessment tool especially covering the cardiovascular component of the disease, novel biomarkers offer a promising tool in sepsis patients.
Highlights
Sepsis still represents a major health care challenge, with mortality rates exceeding25% in Europe [1]
Patients in the HF, the segment elevation myocardial infarction (STEMI) and the sepsis group were significantly more often male (HF: 80.7%, STEMI: 71.2%, sepsis: 69.8% vs. control: 34.7%, p < 0.0001) and diabetes mellitus was more prevalent in these groups than in the control group (HF: 37.0%, STEMI: 29.1%, sepsis: 29.2% vs. control: 17.6%, p = 0.045)
C-reactive protein (CRP), serum creatinine and serum urea were significantly increased in patients with sepsis when compared to the other groups (CRP: median 235.9 mg/l (IQR 93.0–336.6), creatinine: 148.0 μmol/l (IQR 107.3–208.3), see Table 1)
Summary
Sepsis still represents a major health care challenge, with mortality rates exceeding25% in Europe [1]. Due to the high prevalence and death rate, as well as the cost-intensive treatment (which involves ventilation, hemofiltration, extracorporal membrane oxygenation (ECMO) and circulatory support, among others), sepsis constitutes a major economic factor [3,4]. As well as continuous therapy monitoring, remain paramount factors in the treatment of sepsis patients to improve outcomes and prognosis. With the need to further improve outcomes in sepsis, new diagnostic and treatment strategies are under investigation. Since myocardial involvement is assumed to play a major role in sepsis, novel cardiovascular biomarkers represent a promising new approach for diagnosis, as well as for risk stratification in these patients. To further improve outcomes in this patient collective, new cardiovascular biomarkers present a promising opportunity as they target the paramount prognostic processes in sepsis: inflammation and ischemia. We aimed to perform an analysis and comparison of biomarker levels in sepsis and different acute and chronic manifestations of cardiovascular disease by means of STEMI and heart failure
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