Risk factors, host response and outcome of hypothermic sepsis

Autor: Olaf L. Cremer, Lonneke A. van Vught, Nicole P. Juffermans, Maryse A. Wiewel, W. Joost Wiersinga, Marc J. M. Bonten, Tom van der Poll, Matthew B.A. Harmon, Aeilko H. Zwinderman, Janneke Horn, Brendon P. Scicluna, Arie J. Hoogendijk, Marcus J. Schultz
Přispěvatelé: AII - Amsterdam institute for Infection and Immunity, Medical Microbiology and Infection Prevention, Center of Experimental and Molecular Medicine, APH - Amsterdam Public Health, Epidemiology and Data Science, Other departments, ANS - Neuroinfection & -inflammation, Intensive Care Medicine, Infectious diseases
Jazyk: angličtina
Předmět:
Male
Letter
Lipopolysaccharide
medicine.medical_treatment
Hypothermia
Critical Care and Intensive Care Medicine
Body Temperature
chemistry.chemical_compound
0302 clinical medicine
030212 general & internal medicine
Hospital Mortality
Netherlands
Immunity
Cellular
Diseases -- Risk factors
Hypothermia -- Treatment
Immunosuppression
Middle Aged
Host-virus relationships
Intensive Care Units
Treatment Outcome
Mortality -- Case studies
Anesthesia
Female
medicine.symptom
Inflammation Mediators
Septicemia -- Diagnosis
medicine.medical_specialty
Fractalkine
Proinflammatory cytokine
Sepsis
Endothelial activation
03 medical and health sciences
Immune system
medicine
Host response
Journal Article
Humans
Mortality
Intensive care medicine
Aged
business.industry
030208 emergency & critical care medicine
medicine.disease
chemistry
Risk factors
Etiology
business
Zdroj: Critical Care, 20. Springer Science + Business Media
Critical Care
Critical care (London, England), 20(1). Springer Science + Business Media
ISSN: 1364-8535
1466-609X
DOI: 10.1186/s13054-016-1510-3
Popis: Background: Hypothermia is associated with adverse outcome in patients with sepsis. The objective of this study was to characterize the host immune response in patients with hypothermic sepsis in order to determine if an excessive anti-inflammatory response could explain immunosuppression and adverse outcome. Markers of endothelial activation and integrity were also measured to explore potential alternative mechanisms of hypothermia. Finally we studied risk factors for hypothermia in an attempt to find new clues to the etiology of hypothermia in sepsis.
Methods: Consecutive patients diagnosed with sepsis within 24 hours after admission to ICUs in two tertiary hospitals in the Netherlands were included in the study (n = 525). Hypothermia was defined as body temperature below 36 °C in the first 24 h of ICU admission.
Results: Hypothermia was identified in 186 patients and was independently associated with mortality. Levels of proinflammatory and anti-inflammatory cytokines were not different between groups. Hypothermia was also not associated with an altered response to ex vivo stimulation with lipopolysaccharide in a subset of 15 patients. Risk factors for hypothermia included low body mass index, hypertension and chronic cardiovascular insufficiency. Levels of the endothelial activation marker fractalkine were increased during the first 4 days of ICU stay.
Conclusions: Hypothermia during sepsis is independently associated with mortality, which cannot be attributed to alterations in the host immune responses that were measured in this study. Given that risk factors for hypothermic sepsis are mainly cardiovascular and that the endothelial activation marker fractalkine increased in hypothermia, these findings may suggest that vascular dysfunction plays a role in hypothermic sepsis.
peer-reviewed
Databáze: OpenAIRE
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