Abstract
BackgroundThe initial phase of sepsis is characterized by hyperinflammation. Levels of thrombospondin-1 (TSP-1) rise rapidly during acute inflammation. The purpose of this clinical study was to study the association between plasma TSP-1 levels and mortality in patients with sepsis on the intensive care unit.MethodsCritically ill adult patients with sepsis, severe sepsis, or septic shock were included. They were further divided into tertiles based on their baseline plasma TSP-1 concentrations. Primary outcome measure was 28-day mortality. Furthermore, associations with severity of sepsis and platelet counts were studied.ResultsTwo hundred thirty-five patients were included. Median plasma TSP-1 concentrations of the tertiles were 194, 463 and 874 ng/mL, respectively. There were no baseline differences. Mortality rates (26.6, 16.7, and 16.7%, p = 0.20) and cumulative survival curves (p = 0.22) were not statistically different between the tertiles. There was no association of baseline TSP-1 with severity of sepsis (p = 0.08). TSP-1 and platelet counts were positively correlated (159, 198, and 295 × 109/L, p = 0.04).ConclusionsBaseline plasma levels of TSP-1 were not associated with mortality and severity of sepsis in mixed population of septic ICU patients. Further research is needed to clarify the expression of TSP-1 and to unravel the potential prognostic value of this biomarker in human sepsis.
Highlights
The initial phase of sepsis is characterized by hyperinflammation
Patient characteristics Of the 275 patients in the cohort study [18], 30 patients were excluded because they were not suspected of having an infection; nine patients were excluded because the TSP-1 measurements were missing, and one patient with an outlying TSP-1 level on day 1 was excluded
The patients were divided into tertiles based on their baseline TSP-1 level
Summary
The initial phase of sepsis is characterized by hyperinflammation. Levels of thrombospondin-1 (TSP-1) rise rapidly during acute inflammation. The purpose of this clinical study was to study the association between plasma TSP-1 levels and mortality in patients with sepsis on the intensive care unit. Despite improvements in intensive care medicine, sepsis still has an unacceptably high mortality rate (18–36%) [1]. Sepsis should be treated promptly with antibiotics while inflammation does not benefit from this treatment. In both sepsis and inflammation, the immune system plays an important role. Its response can be characterized by hyperinflammation initially, with a subsequent immunosuppressive phase. Immunomodulatory proteins could serve as biomarkers of both inflammation and sepsis
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