The Host Response in Sepsis Patients Developing Intensive Care Unit-acquired Secondary Infections.
Am J Respir Crit Care Med. 2017 Jan 20;:
Authors: van Vught LA, Wiewel MA, Hoogendijk AJ, Frencken JF, Scicluna BP, Klein Klouwenberg PM, Zwinderman AH, Lutter R, Horn J, Schultz MJ, Bonten MM, Cremer OL, van der Poll T
RATIONALE: Sepsis can be complicated by secondary infections. We explored the possibility that sepsis patients developing a secondary infection while in the Intensive Care Unit (ICU) display sustained inflammatory, vascular and procoagulant responses.
OBJECTIVE: To compare systemic proinflammatory host responses in patients with sepsis who acquire a new infection with those who do not.
METHODS: Consecutive sepsis patients with a length of ICU stay >48 hours were prospectively analyzed for the development of ICU-acquired infections. 20 host response biomarkers reflective of key pathways implicated in sepsis pathogenesis were measured during the first four days after ICU admission and at the day of an ICU-acquired infection or noninfectious complication.
MAIN RESULTS: Of 1237 admissions for sepsis (1089 patients), 178 (14.4%) admissions were complicated by ICU-acquired infections (at day 10 [6-13], median with interquartile ranges). Patients who developed a secondary infection showed higher disease severity scores and higher mortality up to 1 year than those who did not. Analyses of biomarkers in patients who later went on to develop secondary infections revealed a more dysregulated host response during the first four days after admission, as reflected by enhanced inflammation, stronger endothelial cell activation, a more disturbed vascular integrity and evidence for enhanced coagulation activation. Host response reactions were similar at the time of ICU-acquired infectious or noninfectious complications.
CONCLUSION: Sepsis patients who developed an ICU-acquired infection showed a more dysregulated proinflammatory and vascular host response during the first four days of ICU admission than those who did not develop a secondary infection.
PMID: 28107024 [PubMed - as supplied by publisher]