Abstract
BackgroundTumor necrosis factor related apoptosis inducing ligand (TRAIL) as a member of the TNF gene superfamily induces apoptosis primarily in tumor cells. TRAIL also plays an important role in the modulation of inflammatory responses, especially in the process of immune paralysis. The aim of the present study was to examine soluble TRAIL (sTRAIL) levels in septic patients in an attempt to explore the association between sTRAIL level and the risk of mortality.MethodsPlasma sTRAIL levels were detected by ELISA in 50 septic patients and 20 healthy volunteers. HLA-DR expression in monocytes was detected by flow cytometry. Selective biochemical parameters were recorded, and patients were monitored in a 28-day period for mortality.ResultsThe mean plasma sTRAIL level in septic patients was significantly lower than that in healthy controls (16.9±8.3 vs. 68.3±8.6 pg/ml, P<0.01), and was significantly higher in 28-day survivors than those in non-survivors (19.4±9.8 vs. 13.9±4.7 pg/ml, P<0.05). Univariate analysis indicated that plasma sTRAIL level was positively correlated with monocyte and lymphocyte counts and HLA-DR expression level (r = 0.5, P<0.01; r = 0.3, P<0.05; r = 0.43, P<0.01, respectively). STRAIL level was negatively correlated with APACHE II score, BUN and age (r = −0.48, P<0.01; r = −0.29, P<0.05; r = −0.45, P<0.01, respectively). Multiple linear regression analysis indicated that the predictor of plasma soluble TRAIL level was HLA-DR expression (P<0.01).ConclusionLow plasma sTRAIL levels were associated with immune paralysis and a high risk of mortality in patients with septic shock. sTRAIL may prove to be a potential biomarker of immune function and predict the survival of septic patients.
Highlights
Sepsis, a systemic inflammatory response syndrome (SIRS) caused by severe infections, is one of the leading causes of admission to intensive care units (ICUs) [1]
We reported for the first time that soluble TRAIL (sTRAIL) was significantly down-regulated in septic patients as compared with that in healthy controls. sTRAIL level was positively correlated with monocyte and lymphocyte counts and HLA-DR expression on monocytes, and was negatively correlated with blood urea nitrogen (BUN) and age
Tumor necrosis factor related apoptosis inducing ligand (TRAIL) is a novel member of the TNF super family, as well as a protein functioning as a ligand that induces the process of cell apoptosis
Summary
A systemic inflammatory response syndrome (SIRS) caused by severe infections, is one of the leading causes of admission to intensive care units (ICUs) [1]. Despite an improved understanding about the pathogenesis of sepsis in recent years, it remains a clinical challenge due to high morbidity and mortality [2]. The prevailing concept of the pathogenesis of sepsis is a consequence of an overwhelming host inflammatory response to invading pathogens. Some recent studies [4] indicate that most septic patients survived during the hyper-inflammatory phase but tended to die during the stage of prolonged immunosuppression. The aim of the present study was to examine soluble TRAIL (sTRAIL) levels in septic patients in an attempt to explore the association between sTRAIL level and the risk of mortality
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