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Critical Care
Published in: Critical Care 4/2010

Open Access 01-08-2010 | Research

Proven infection-related sepsis induces a differential stress response early after ICU admission

Authors: Olivier Lesur, Jean-Francois Roussy, Frederic Chagnon, Nicole Gallo-Payet, Robert Dumaine, Philippe Sarret, Ahmed Chraibi, Lucie Chouinard, Bruno Hogue

Published in: Critical Care | Issue 4/2010

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Abstract

Introduction

Neuropeptides arginine-vasopressin (AVP), apelin (APL), and stromal-derived factor-1α (SDF-1α) are involved in the dysfunction of the corticotropic axis observed in septic ICU patients. Study aims were: (i) to portray a distinctive stress-related neuro-corticotropic systemic profile of early sepsis, (ii) to propose a combination data score, for aiding ICU physicians in diagnosing sepsis on admission.

Methods

This prospective one-center observational study was carried out in a medical intensive care unit (MICU), tertiary teaching hospital. Seventy-four out of 112 critically ill patients exhibiting systemic inflammatory response syndrome (SIRS) were divided into two groups: proven sepsis and non sepsis, based on post hoc analysis of microbiological criteria and final diagnosis, and compared to healthy volunteers (n = 14). A single blood sampling was performed on admission for measurements of AVP, copeptin, APL, SDF-1α, adrenocorticotropic hormone (ACTH), cortisol baseline and post-stimulation, and procalcitonin (PCT).

Results

Blood baseline ACTH/cortisol ratio was lower and copeptin higher in septic vs. nonseptic patients. SDF-1α was further increased in septic patients vs. normal patients. Cortisol baseline, ACTH, PCT, APACHE II and sepsis scores, and shock on admission, were independent predictors of sepsis diagnosis upon admission. Using the three first aforementioned categorical bio-parameters, a probability score for predicting sepsis yielded an area under the Receiver Operating Curve (ROC) curves better than sepsis score or PCT alone (0.903 vs 0.727 and 0.726: P = 0.005 and P < 0.04, respectively).

Conclusions

The stress response of early admitted ICU patients is different in septic vs. non-septic conditions. A proposed combination of variable score analyses will tentatively help in refining bedside diagnostic tools to efficiently diagnose sepsis after further validation.
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Literature
1.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29: 1303-1310.CrossRefPubMed
2.
Abraham E, Singer M: Mechanism of sepsis-induced organ dysfunction. Crit Care Med 2007, 35: 2408-2416.CrossRefPubMed
3.
Maxime V, Siami S, Annane D: Metabolism modulators in sepsis: the abnormal pituitary response. Crit Care Med 2007, 35: S596-S601.CrossRefPubMed
4.
Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, Keh D, Briegel J, Beishuizen A, Dimopoulou I, Tsagarakis S, Singer M, Chrousos GP, Zaloga G, Bokhari F, Vogeser M: Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med 2008, 36: 1937-1949.CrossRefPubMed
5.
Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E: A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 2000, 283: 1038-1045.CrossRefPubMed
6.
Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaud P, Bellissant E: Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002, 288: 862-871.CrossRefPubMed
7.
Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG, Benbenishty J, Kalenka A, Forst H, Laterre PF, Reinhart K, Cuthbertson BH, Payen D, Briegel J: Hydrocortisone therapy for patients with septic shock. N Engl J Med 2008, 358: 111-124.CrossRefPubMed
8.
Aguilera G, Rabadan-Diehl C: Vasopressinergic regulation of the hypothalamic-pituitary-adrenal axis: implications for stress adaptation. Regul Pept 2000, 96: 23-29.CrossRefPubMed
9.
Gallo-Payet N, Roussy JF, Chagnon F, Roberge C, Lesur O: Hypothalamic-pituitary-adrenal axis and MODS in critical illness: special focus on arginine-vasopressin (AVP) and apelin (APL). Journal of Organ Dysfunction 2008, 4: 216-229.CrossRef
10.
Tatemoto K, Hosoya M, Habata Y, Fujii R, Kakegawa T, Zou MX, Kawamata Y, Fukusumi S, Hinuma S, Kitada C, Kurokawa T, Onda H, Fujino M: Isolation and characterization of a novel endogenous peptide ligand for the human APJ receptor. Biochem Biophys Res Commun 1998, 251: 471-476.CrossRefPubMed
11.
Llorens-Cortes C, Moos F: Opposite potentiality of hypothalamic coexpressed neuropeptides, apelin and vasopressin in maintaining body fluid homeostasis. Prog Brain Res 2008, 170: 559-570.CrossRefPubMed
12.
Callewaere C, Banisadr G, Desarmenien MG, Mechighel P, Kitabgi P, Rostene WH, Melik Parsadaniantz S: The chemokine SDF-1/CXCL12 modulates the firing pattern of vasopressin neurons and counteracts induced vasopressin release through CXCR4. Proc Natl Acad Sci USA 2006, 103: 8221-8226.PubMedCentralCrossRefPubMed
13.
Schuetz P, Christ-Crain M, Muller B: Biomarkers to improve diagnostic and prognostic accuracy in systemic infections. Curr Opin Crit Care 2007, 13: 578-585.CrossRefPubMed
14.
Struck J, Morgenthaler NG, Bergmann A: Copeptin, a stable peptide derived from the vasopressin precursor, is elevated in serum of sepsis patients. Peptides 2005, 26: 2500-2504.CrossRefPubMed
15.
Jochberger S, Velik-Salchner C, Mayr VD, Luckner G, Wenzel V, Falkensammer G, Ulmer H, Morgenthaler N, Hasibeder W, Dunser MW: The vasopressin and copeptin response in patients with vasodilatory shock after cardiac surgery: a prospective, controlled study. Intensive Care Med 2009, 35: 489-497.CrossRefPubMed
16.
Jochberger S, Morgenthaler NG, Mayr VD, Luckner G, Wenzel V, Ulmer H, Schwarz S, Hasibeder WR, Friesenecker BE, Dunser MW: Copeptin and arginin vasopressin concentrations in critically ill patients. J Clin Endocrinol Metab 2006, 91: 4381-4386.CrossRefPubMed
17.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003, 31: 1250-1256.CrossRefPubMed
18.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall JC, Ranieri M, Ramsay G, Sevransky J, Thompson T, Townsend S, Vender JS, Zimmerman , Vincent JL: Surviving Sepsis Campaign guidelines: International guidelines for management of severe sepsis and septic shock. Crit Care Med 2008, 36: 296-327.CrossRefPubMed
19.
Lauzier F, Levy B, Lamarre P, Lesur O: Vasopressin or norepinephrine in early hyperdynamic septic shock: a randomized clinical trial. Intensive Care Med 2006, 32: 1782-1789.CrossRefPubMed
20.
Shapiro NI, Trzeciak S, Hollander JE, Birkhahn R, Otero R, Osborn TM, Moretti E, Nguyen HB, Gunnerson KJ, Milzman D, Gaieski DF, Goyal M, Cairns CB, Ngo L, Rivers EP: A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis. Crit Care Med 2009, 37: 96-104.CrossRefPubMed
21.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006, 10: R73.PubMedCentralCrossRefPubMed
22.
Bornstein SR, Engeland WC, Ehrhart-Bornstein M, Herman JP: Dissociation of ACTH and glucocorticoids. Trends Endocrinol Metab 2008, 19: 175-180.CrossRefPubMed
23.
Dimopoulou I, Stamoulis K, Ilias I, Tzanela M, Lyberopoulos P, Orfanos S, Armaganidis A, Theodorakopoulou M, Tsagarakis S: A prospective study on adrenal cortex responses and outcome prediction in acute critical illness: results from a large cohort of 203 mixed ICU patients. Intensive Care Med 2007, 33: 2116-2121.CrossRefPubMed
24.
Marx C, Petros S, Bornstein SR, Weise M, Wendt M, Menschikowski M, Engelmann L, Hoffken G: Adrenocortical hormones in survivors and nonsurvivors of severe sepsis: diverse time course of dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and cortisol. Crit Care Med 2003, 31: 1382-1388.CrossRefPubMed
25.
Dunser MW, Hasibeder WR, Wenzel V, Schwarz S, Ulmer H, Knotzer H, Pajk W, Friesenecker BE, Mayr AJ: Endocrinologic response to vasopressin infusion in advanced vasodilatory shock. Crit Care Med 2004, 32: 1266-1271.CrossRefPubMed
26.
Annane D, Maxime V, Ibrahim F, Alvarez JC, Abe E, Boudou P: Diagnosis of adrenal insufficiency in severe sepsis and septic shock. Am J Respir Crit Care Med 2006, 174: 1319-1326.CrossRefPubMed
27.
Riche FC, Boutron CM, Valleur P, Berton C, Laisne MJ, Launay JM, Chappuis P, Peynet J, Vicaut E, Payen D, Cholley BP: Adrenal response inpatients with septic shock of abdominal origin: relationship to survival. Intensive Care Med 2007, 33: 1761-1766.CrossRefPubMed
28.
Venkatesh B, Cohen J, Hickman I, Nisbet J, Thomas P, Ward G, Hall J, Prins J: Evidence of altered cortisol metabolism in critically ill patients: a prospective study. Intensive Care Med 2007, 33: 1746-1753.CrossRefPubMed
29.
Bendel S, Karlsson S, Pettila V, Loisa P, Varpula M, Ruokonen E, Finnsepsis Study Group: Free cortisol in sepsis and septic shock. Anesth Analg 2008, 106: 1813-1819.CrossRefPubMed
30.
Lipinier-Fredman D, Sprung CL, Laterre PF, Weiss Y, Goodman SV, Vogeser M, Briegel J, Keh D, Singer M, Moreno R, Bellissant E, Annane D, Corticus Study Group: Adrenal function in sepsis: the retrospective Corticus cohort study. Crit Care Med 2007, 35: 1012-1018.CrossRef
31.
Karlsson S, Varpula M, Ruokonen E, Pettila V, Parviainen I, Ala-Kokko TI, Kolho E, Rintala EM: Incidence, treatment, and outcome of severe in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Med 2007, 33: 435-443.CrossRefPubMed
32.
Le Roux CW, Chapman GA, Kong WM, Dhillo WS, Jones J, Alaghband-Zadeh J: Free cortisol index is better than serum total cortisol in determining hypothalamic-pituitary-adrenal status in patients undergoing surgery. J Clin Endocrinol Metab 2003, 88: 2045-2048.CrossRefPubMed
33.
Ho JT, Al-Musalhi H, Chapman MJ, Quach T, Thomas PD, Bagley CJ, Lewis JG, Torpy DJ: Septic shock and sepsis: a comparison of total and free plasma cortisol levels. J Clin Endocrinol Metab 2006, 91: 105-114.CrossRefPubMed
34.
Nicholson JP, Wolmarans MR, Park GR: The role of albumin in critical illness. Br J Anaesth 2000, 85: 599-610.CrossRefPubMed
35.
Vermes I, Beishuizen A, Hampsink RM, Haanen C: Dissociation of plasma adrenocorticotropin and cortisol levels in critically ill patients: possible role of endothelin and atrial natriuretic hormone. J Clin Endocrinol Metab 1995, 80: 1238-1242.PubMed
36.
Van den Berghe GH: The neuroendocrine stress response and modern intensive care: the concept revisited. Burns 1999, 25: 7-16.CrossRefPubMed
37.
Cho YM, Kim SY, CHO BY, Lee HK, Yang HK, Lee KU: Dissociation between plasma adrenocorticotropin and serum cortisol level during the early postoperative period after gastrectomy. Horm Res 2000, 53: 246-250.CrossRefPubMed
38.
Bornstein SR, Chrousos GP: Clinical review 104: Adrenocorticotropin (ACTH)- and non-ACTH-mediated regulation of the adrenal cortex: neural and immune inputs. J Clin Endocrinol Metab 1999, 84: 1729-1736.CrossRefPubMed
39.
Marx C, Ehrhart-Bornstein M, Scherbaum WA, Bornstein SR: Regulation of adrenocortical function by cytokines-relevance for immune endocrine interaction. Horm Metab Res 1998, 30: 416-420.CrossRefPubMed
40.
Barbieri F, Bajetto A, Porcile C, Pattarozzi A, Scettini G, Florio T: Role of stromal cell-derived factor 1 (SDF1/CXCL12) in regulating anterior pituitary function. J Mol Endocrinol 2007, 38: 383-389.CrossRefPubMed
41.
Becchi C, Pillozzi S, Fabbri LP, Al Malyan M, Cacciapuoti C, Della Bella C, Nucera M, Masselli M, Boncinelli S, Arcangeli A, Amedei A: The increase of endothelial progenitor cells in the peripheral blood: a new parameter for detecting onset and severity of sepsis. Int J Immunopathol Pharmacol 2008, 21: 697-705.PubMed
42.
Cribbs S, Rojas M, Taylor R: Circulating endothelial progenitor cells are inversely associated with respiratory organ dysfunction in sepsis. Crit Care Med 2008, 36: A76.CrossRef
43.
Bernhagen J, Krohn R, Lue H, Gregory JL, Zernecke A, Koenen RR, Dewor M, Georgiev I, Schober A, Leng L, Kooistra T, Fingerle-Rowson G, Ghezzi P, Kleemann R, McColl SR, Bucala R, Hickey MJ, Weber C: MIF is a noncognate ligand of CXC chemokine receptors in inflammatory and atherogenic cell recruitment. Nat Med 2007, 13: 587-596.CrossRefPubMed
44.
Russel JA, Walley KR, Gordon AC, Cooper DJ, Hebert PC, Singer J, Holmes CL, Mehta S, Granton JT, Storms MM, Cook DJ, Presneill JJ, Dieter Ayers for the Vasopressin and Septic Shock Trial Investigators: Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock. Crit Care Med 2009, 37: 811-818.CrossRef
45.
Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D: Circulating vasopressin levels in septic shock. Crit Care Med 2003, 31: 1752-1758.CrossRefPubMed
46.
Bauer SR, Lam SW, Cha SS, Oyen LJ: Effect of corticosteroids on arginine vasopressin-containing vasopressor therapy for septic shock: a case control study. J Crit Care 2008, 23: 500-506.CrossRefPubMed
47.
Ertmer C, Bone HG, Morelli A, Van Aken H, Erren M, Lange M, Traber DL, Westphal M: Methylprednisolone reverses vasopressin hyporesponsiveness in ovine endotoxemia. Shock 2007, 27: 281-288.CrossRefPubMed
48.
Bucher M, Hobbhahn J, Taeger K, Kurtz A: Cytokine-mediated downregulation of vasopressin V(1A) receptors during acute endotoxemia in rats. Am J Physiol Regul Integr Comp Physiol 2002, 282: R979-R984.CrossRefPubMed
49.
Watters JJ, Swank MW, Wilkinson CW, Dorsa DM: Evidence for glucocorticoid regulation of the rat vasopressin V1a receptor gene. Peptides 1996, 17: 67-73.CrossRefPubMed
50.
Ugarte H, Silva E, Mercan D, De Mendonca A, Vincent JL: Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 1999, 27: 498-504.CrossRefPubMed
51.
Christ-Crain M, Stolz D, Jutla S, Couppis O, Muller C, Bingisser R, Schuetz P, Tamm M, Edwards R, Muller B, Grossman AB: Free and total cortisol levels as predictors of severity and outcome in community-acquired pneumonia. Am J Respir Crit Care Med 2007, 176: 913-920.CrossRefPubMed
Metadata
Title
Proven infection-related sepsis induces a differential stress response early after ICU admission
Authors
Olivier Lesur
Jean-Francois Roussy
Frederic Chagnon
Nicole Gallo-Payet
Robert Dumaine
Philippe Sarret
Ahmed Chraibi
Lucie Chouinard
Bruno Hogue
Publication date
01-08-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9102

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