Abstract
Previously, researchers found higher serum substance P (SP) concentrations in survivors of severe sepsis than in non-survivors at the time of severe sepsis diagnosis. The objectives of our current study were to determine whether there is an association between serum SP levels during the first week and sepsis mortality, sepsis severity, serum levels of tumor necrosis factor (TNF)-α and interleukin (IL)-10, and whether serum SP levels during the first week could be used as a biomarker of sepsis mortality. We determined serum concentration of SP, TNF-α, and IL-10 at days 1, 4, and 8. The end-point of the study was mortality at 30 days. We found that non-survivor (n = 104) compared to survivor patients (n = 206) showed lower serum SP levels at days 1, 4, and 8 (p < 0.001). Multiple logistic regression analyses showed an association between 30-day mortality and serum SP levels at days 1, 4, and 8 (p < 0.001) controlling for SOFA score, diabetes mellitus, age, and lactic acid levels. The most interesting findings of our study were that there is an association between serum SP levels during the first week and sepsis mortality, and that serum SP levels during the first week could be used as a biomarker of sepsis mortality.
Highlights
Sepsis carries a large number of deaths and health care costs annually [1,2]
We found that non-survivors with severe sepsis compared to survivors had lower platelet count, and higher age, SOFA score, lactic acid, international normalized ratio (INR), creatinine, activated partial thromboplastin time (aPTT), Acute Physiology and Chronic Health Evaluation (APACHE)-II score, serum IL-10 levels, and rate of diabetes mellitus
We found a higher risk of death risk in patients with serum substance P (SP) levels < 339 pg/mL at the time of severe sepsis diagnosis than in patients with higher concentrations (Hazard Ratio = 3.5; 95% confidence intervals (CI) = 2.35–5.18; p < 0.001), in patients with serum SP levels < 203 pg/mL at day 4, and in patients with serum SP levels < 148 pg/mL at day 8
Summary
Sepsis carries a large number of deaths and health care costs annually [1,2]. Tachykinin family includes substance P (SP), neurokinin A (NKA), neurokinin B (NKB), and endokinins [3,4,5,6,7,8,9,10,11,12]. Tachykinins are present in the peripheral and central nervous systems, respiratory system, urinary system, immune system, gut, and blood vessels. Tachykinins are involved in different biological processes, such as transmission of nociceptive responses, airway contraction, salivary secretion, smooth muscle contraction, inflammation, vasodilatation, and plasma protein extravasation. SP is involved in different diseases, such as asthma, psoriasis, inflammatory bowel disease, anxiety, migraine, psychosis, and central and peripheral nervous systems injury [3,4,5,6,7,8,9,10,11,12]. SP is considered one of the major initiators of neurogenic inflammation
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