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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2004

01-07-2004 | Neonatal and Pediatric Intensive Care

Increased incidence and severity of the systemic inflammatory response syndrome in patients deficient in mannose-binding lectin

Authors: Katy J. Fidler, Peter Wilson, Jane C. Davies, Malcolm W. Turner, Mark J. Peters, Nigel J. Klein

Published in: Intensive Care Medicine | Issue 7/2004

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Abstract

Objective

To determine whether pediatric PICU patients with mannose-binding lectin (MBL) gene polymorphisms associated with low levels of the functional protein have an increased risk of developing sepsis and SIRS.

Design and setting

A prospective, observational cohort study in a 22-bed PICU in a tertiary referral centre.

Patients

One hundred consecutive admissions to a PICU with at least one organ system failure longer than 12 h. Patients were classified into those with infectious or non-infectious insults as the primary reason for intensive care admission. Patients were followed to determine which developed sepsis or non-infection related SIRS using standard criteria.

Measurements and results

Of the 100 patients 50 had infectious and 50 had non-infectious insults as the precipitant for admission. 42 patients had variant MBL alleles (determined by MBL-2 gene exon 1 and promoter polymorphisms) and were significantly over-represented amongst the 59 patients that developed SIRS. This effect was not explained by differences in age, sex or ethnicity and was seen in both the infection and non-infection subgroups. In patients with infection, variant MBL alleles were associated with increased systemic response (2/15 with localised infection, 10/19 with sepsis and 12/16 with septic shock). MBL serum levels showed close concordance with the genotype and indicated that MBL levels less than 1000 ng/ml are associated with a greatly increased risk of SIRS.

Conclusions

MBL-2 exon 1 polymorphisms with low serum levels of functional MBL protein are associated with a greatly increased risk of developing SIRS and of progression from infection to sepsis and septic shock in paediatric ICU patients.
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Metadata
Title
Increased incidence and severity of the systemic inflammatory response syndrome in patients deficient in mannose-binding lectin
Authors
Katy J. Fidler
Peter Wilson
Jane C. Davies
Malcolm W. Turner
Mark J. Peters
Nigel J. Klein
Publication date
01-07-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2303-8

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