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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2015 February;81(2):125-34
Elevated soluble endothelial protein C receptor levels at ICU admission are associated with sepsis development
Vassiliou A. G. 1, Kotanidou A. 1, 2, Mastora Z. 2, Maniatis N. A. 1, 3, Albani P. 2, Jahaj E. 2, Koutsoukou A. 1, Armaganidis A. 3, Orfanos S. E. 1, 3 ✉
1 GP Livanos and M Simou Laboratories, First Department of Critical Care Medicine & Pulmonary Services, Medical School of Athens University, Evangelismos Hospital, Athens, Greece;
2 First Department of Critical Care Medicine and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital, Athens, Greece;
3 Second Department of Critical Care, Medical School of Athens University, “Attikon” Hospital, Haidari Athens, Greece
BACKGROUND: The endothelial protein C receptor (EPCR) is a protein that regulates the protein C anticoagulant and anti-inflammatory pathways. A soluble form of EPCR (sEPCR) circulates in plasma and inhibits activated protein C (APC) activities. The clinical impact of sEPCR and its involvement in the septic process is under investigation. In this study, we assessed the role of sEPCR levels as an early indicator of sepsis development.
METHODS: Plasma sEPCR levels were measured in 59 critically-ill non-septic patients at the time of admission to the intensive care unit (ICU). Multiple logistic regression analysis was performed to identify potential risk factors for sepsis development and Cox-Regression models were fitted for variables to examine their relationship with time to sepsis development.
RESULTS: Thirty patients subsequently developed sepsis and 29 did not. At ICU admission, sequential organ failure assessment (SOFA) scores were significantly higher in the subsequent sepsis group as compared to the non sepsis group (mean ± SD: 6.4±2.7 and 5±2.3, respectively, P=0.037). sEPCR levels were also higher in the patients who subsequently developed sepsis compared to the patients who did not (median and interquartile range: 173.4 [104.5-223.5] ng/mL vs. 98.3 [69.8-147.7] ng/mL, respectively; P=0.004). Cox regression analysis identified sEPCR as the only parameter related to sepsis development with time (relative risk: 1.078, 95% confidence interval: 1.016-1.144, by 10 units; P=0.013).
CONCLUSION: Upon ICU admission, sEPCR levels in initially non-septic critically-ill patients appear elevated in the subjects who will subsequently become septic.