Extracellular Hsp70 is a mortality predictor in septic shock and correlates with APACHE II, SOFA and inflammatory cytokines

Abstract

BackgroundSeptic shock mortality ranges from 30 to 60%. Intracellular Hsp70 is a protein involved in the folding of mature proteins, its extracellular detection has been described in rheumatoid arthritis and several infectious diseases. The aims of the study were to determine if eHsp70 levels in adult patients with septic shock could be a prognostic marker and if it correlated with APACHE II and SOFA scores and the inflammatory cytokines response.MethodsWe performed an observational, longitudinal, prospective, cohort study. Adult patients with septic shock admitted to the Intensive Care Unit were included. eHsp70 levels were measured in sera by ELISA, APACHE and SOFA were determined on ICU admission and every 2 days until death or discharge for improvement. Serum cytokines were measured at the admission and discharge with flow cytometry.ResultsNinety patients were included, 53 men and 37 women. Fifty percent (45) died. Higher APACHE II and SOFA scores, were found on those who died compared to survivors. Ninety‐one percent of patients who had persistent levels above 500 pg/ml of eHsp70 up to days 14 and 16 of hospitalization died; eHsp70 above 600 pg/ml was related with APACHE score higher than 30 and SOFA score higher than 15 and correlated with deaths. IL‐6, IL‐8 and IL‐18 were higher in deceased patients. eHsp70 persistent levels above 500 pg/ml could be related with mortality.ConclusionsPatients with APACHE II score higher than 30 and SOFA score higher than 15 correlated with eHsp70 above 600 pg/ml and a higher proinflammatory response in the death group. eHsp70 could be a severity marker in patients with septic shock.Support or Funding InformationThis work was supported by Federal Funds from the Departamento de Investigación del Hospital General de México “Dr. Eduardo Liceaga”