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 |
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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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