proven infection-related sepsis induces a differential stress response early after icu admission证明感染相关性败血症引发一个微分入住icu后早期应激反应.pdfVIP

Lesur et al. Critical Care 2010, 14:R131 /content/14/4/R131 R E S E A R C H Open Access Research Proven infection-related sepsis induces a differential stress response early after ICU admission 1,2 1,2 2 3 3 3 Olivier Lesur* , Jean-Francois Roussy , Frederic Chagnon , Nicole Gallo-Payet , Robert Dumaine , Philippe Sarret , 3 3 2 Ahmed Chraibi , Lucie Chouinard and Bruno Hogue Abstract Introduction: Neuropeptides arginine-vasopressin (AVP), apelin (APL), and stromal-derived factor-1α (SDF-1α) are involved in the dysfunction of the corticotropic axis observed in septic ICU patients. Study aims were: (i) to portray a distinctive stress-related neuro-corticotropic systemic profile of early sepsis, (ii) to propose a combination data score, for aiding ICU physicians in diagnosing sepsis on admission. Methods: This prospective one-center observational study was ca rried out in a medical intensive care unit (MICU), tertiary teaching hospital. Seventy-four out of 112 critically ill patients exhibiting systemic inflammatory response syndrome (SIRS) were divided into two groups: proven sepsis and non sepsis, based on post hoc analysis of microbiological criteria and final diagnosis, and compared to healthy volunteers (n = 14). A single blood sampling was performed on admission for measurements of AVP, copeptin, APL, SDF-1α, adrenocorticotropic hormone (ACTH), cortisol baseline and post-stimulation, and procalcitonin (PCT). Results: Blood baseline ACTH/cortisol ratio was lower and copeptin higher in septic vs. nonseptic patients. SDF-1α was further increased in septic patients vs. normal patients. Cortisol baseline,