Abstract
IntroductionSevere sepsis is a disease of the microcirculation, with endothelial dysfunction playing a key role in its pathogenesis and subsequent associated mortality. Angiogenesis in damaged small vessels may ameliorate this dysfunction. The aim of the study was to determine whether the angiogenic factors (vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and angiopoietin-1 (Ang-1) and -2 (Ang-2)) are mortality indicators in Malawian children with severe bacterial infection.MethodsIn 293 children with severe bacterial infection, plasma VEGF, PDGF, FGF, and Ang-1 and Ang-2 were measured on admission; in 50 of the children with meningitis, VEGF, PDGF, and FGF were also measured in the CSF. Healthy controls comprised children from some of the villages of the index cases. Univariable and multivariable logistic regression analyses were performed to develop a prognostic model.ResultsThe median age was 2.4 years, and the IQR, 0.7 to 6.0 years. There were 211 children with bacterial meningitis (72%) and 82 (28%) with pneumonia, and 154 (53%) children were HIV infected. Mean VEGF, PDGF, and FGF concentrations were higher in survivors than in nonsurvivors, but only PDGF remained significantly increased in multivariate analysis (P = 0.007). Mean Ang-1 was significantly increased, and Ang-2 was significantly decreased in survivors compared with nonsurvivors (6,000 versus 3,900 pg/ml, P = 0.03; and 7,700 versus 11,900 pg/ml, P = 0.02, respectively). With a logistic regression model and controlling for confounding factors, only female sex (OR, 3.95; 95% CI, 1.33 to 11.76) and low Ang-1 (OR, 0.23; 95% CI, 0.08 to 0.69) were significantly associated with mortality. In children with bacterial meningitis, mean CSF VEGF, PDGF, and FGF concentrations were higher than paired plasma concentrations, and mean CSF, VEGF, and FGF concentrations were higher in nonsurvivors than in survivors (P = 0.02 and 0.001, respectively).ConclusionsLower plasma VEGF, PDGF, FGF, and Ang-1 concentrations and higher Ang-2 concentrations are associated with an unfavorable outcome in children with severe bacterial infection. These angiogenic factors may be important in the endothelial dysregulation seen in severe bacterial infection, and they could be used as biomarkers for the early identification of patients at risk of a poor outcome.
Highlights
Severe sepsis is a disease of the microcirculation, with endothelial dysfunction playing a key role in its pathogenesis and subsequent associated mortality
In contrast to plasma concentrations, mean CSF, Vascular endothelial growth factor (VEGF), and Fibroblast growth factor (FGF) concentrations were higher in nonsurvivors than in survivors (1,178 versus 216 pg/ml; P = 0.02; and 939 versus 501 pg/ml; P = 0.001, respectively)
Our study examined both growth factors and angiogenic factors in 293 children and demonstrates that among Malawian children with severe bacterial infection, high plasma VEGF, Platelet-derived growth factor (PDGF), FGF, and Ang-1 concentrations are associated with a favorable outcome
Summary
Severe sepsis is a disease of the microcirculation, with endothelial dysfunction playing a key role in its pathogenesis and subsequent associated mortality. Angiogenesis in damaged small vessels may ameliorate this dysfunction. The aim of the study was to determine whether the angiogenic factors (vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and angiopoietin-1 (Ang-1) and -2 (Ang2)) are mortality indicators in Malawian children with severe bacterial infection. From the bone marrow ameliorate the dysfunction caused by severe sepsis, and this process is thought to be mediated by angiogenesis in ischemic areas and in damaged small vessels [4,5]. Vascular endothelial growth factor (VEGF), a dimeric 46-kDa glycoprotein, is an endothelial cell-specific, multifunctional cytokine. Platelet-derived growth factor (PDGF) has angiogenic effects and stimulates endothelial cell migration [8,9]. Fibroblast growth factor (FGF) promotes angiogenesis and has antiapoptotic effects [11,12]. Elevated CSF levels of FGF have been observed in children with bacterial meningitis and are associated with poor outcome, suggesting neurotropic effects [13]
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