High adenosine plasma concentration as a prognostic index for outcome in patients with septic shock
| Autor: | Régis Guieu, Marie-Laure Ayem, Claude Martin, Marc Leone, Xavier Viviand |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Adenosine Critical Care Endothelium Shock Hemorrhagic Critical Care and Intensive Care Medicine Sepsis Adenosine deaminase Reference Values Blood plasma Humans Medicine Shock Traumatic Prospective Studies Aged biology business.industry Septic shock Middle Aged Prognosis medicine.disease Shock Septic Pathophysiology Survival Rate medicine.anatomical_structure Immunology biology.protein Vascular resistance Female business medicine.drug |
| Zdroj: | Critical Care Medicine. 28:3198-3202 |
| ISSN: | 0090-3493 |
| Popis: | epsis is an increasingly com-mon cause of morbidity andmortality in critically ill pa-tients (1, 2). Sepsis and septicshock, as disease entities, represent con-glomerates of multiple factors contribut-ing to systemic inflammation, multipleorgan failure, and often, death. Sepsisand its sequels represent a continuum ofclinical and pathophysiologic severity.The degree of severity independently af-fects prognosis. Several clinically recog-nizable stages along this continuum in-clude sepsis, severe sepsis, and septicshock (3–6).Hemodynamic abnormalities associ-ated with infection are often character-ized by high cardiac output and lowsystemic vascular resistance. Many sub-stances have been implicated in the phys-iopathology of sepsis or septic shock (7),including cytokines (8). Among thesesubstances, adenosine, a purine nucleo-side, may participate in the hemody-namic disturbances of critical illness andespecially in sepsis or septic shock. Aden-osine is released extracellularly by endo-thelial cells and myocytes after intracel-lular dephosphorylation by a 59-nucleotidase (9). Extracellular adenosineconcentration depends on the uptake ofadenosine by red blood cells via an equili-brative carrier recently cloned (10) and ofan adenosine deaminase that degradesadenosine into inosine (9). Under cir-cumstances of metabolic stress, a rapidand massive depletion of intracellularadenosine triphosphate occurs, leading toaccumulation of adenosine monophos-phate(AMP)that,inturn,isdephosphory-lated into adenosine. Adenosine metabo-lism abnormalities may participate in thephysiopathology of sepsis or septic shockfor the following reasons: a) adenosine isa strong vasodilating agent (11) and someadenosine derivatives control blood pres-sure; b) high plasma adenosine concen-tration may participate in hemodynamicfailure because adenosine induces brady-cardia and causes a rapid drop in bloodpressure (11, 12); c) adenosine plays a animportant role in organ hyperperfusionafter ischemia-reperfusion (13); and d)adenosine production is enhanced in re-gions of altered metabolic supply/demanddynamics (14) or increased adrenergic ac-tivity (9), and this may play a vital role invascular modifications during sepsis.In light of these data, we speculatethat adenosine contributes to the hemo-dynamic derangements observed duringseptic shock. Thus, our study was de-signed to evaluate changes in plasmaadenosine concentrations (APC) overtime in septic shock patients, and in pa-tients with severe sepsis, an earlier stagein the response to systemic infection. Wealso investigated APC in traumatic/hypovolemic shock, a syndrome with se |
| Databáze: | OpenAIRE |
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