Elevated nucleosome levels in systemic inflammation and sepsis*
作者:
Sacha Zeerleder,
Bas Zwart,
Walter Wuillemin,
Lucien Aarden,
A. B. Groeneveld, MD,
Christoph Caliezi, MD,
Annemarie van Nieuwenhuijze,
Gerard van Mierlo,
Anke Eerenberg,
Bernhard Lämmle,
C. Hack,
期刊:
Critical Care Medicine
(OVID Available online 2003)
卷期:
Volume 31,
issue 7
页码: 1947-1951
ISSN:0090-3493
年代: 2003
出版商: OVID
关键词: sepsis;multiple organ dysfunction syndrome;apoptosis;nucleosome
数据来源: OVID
摘要:
ObjectiveMultiple organ dysfunction syndrome is a frequent complication of severe sepsis and septic shock and has a high mortality. We hypothesized that extensive apoptosis of cells might constitute the cellular basis for this complication.DesignRetrospective study.SettingMedical and surgical wards or intensive care units of two university hospitals.PatientsFourteen patients with fever, 15 with systemic inflammatory response syndrome, 32 with severe sepsis, and eight with septic shock.InterventionsNone.Measurements and Main ResultsWe assessed circulating levels of nucleosomes, specific markers released by cells during the later stages of apoptosis, with a previously described enzyme-linked immunosorbent assay in these 69 patients with fever, systemic inflammatory response syndrome, severe sepsis, or septic shock. Severity of multiple organ dysfunction syndrome was assessed with sepsis scores, and clinical and laboratory variables. Elevated nucleosome levels were found in 64%, 60%, 94%, and 100% of patients with fever, systemic inflammatory response syndrome, severe sepsis, or septic shock, respectively. These levels were significantly higher in patients with septic shock as compared with patients with severe sepsis, systemic inflammatory response syndrome, or fever, and in nonsurvivors as compared with survivors. In patients with advanced multiple organ dysfunction syndrome, nucleosome levels correlated with cytokine plasma levels as well as with variables predictive for outcome.ConclusionsPatients with severe sepsis and septic shock have elevated plasma levels of nucleosomes. We suggest that apoptosis, probably resulting from exposure of cells to excessive amounts of inflammatory mediators, might by involved in the pathogenesis of multiple organ dysfunction syndrome.
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