Persistent low serum zinc is associated with recurrent sepsis in critically ill patients - A pilot study.

Zinc is an essential trace element for both pathogens and hosts. Hypozincemia is a well known phenomenon in sepsis patients and represents the innate immune systems attempt to deprive pathogens of zinc. However little is known about course, restitution and prognostic value of serum zinc levels in sepsis patients. We performed a prospective observational single-center study set in a tertiary care university hospital intensive care unit. Serum zinc levels were singularly measured of healthy controls and sequentially of surgical sepsis patients and surgical patients over a 8-day period. Throughout the study period, we report significantly decreased serum zinc levels in surgical and surgical sepsis patients compared to healthy controls. Lower serum zinc levels in surgical sepsis patients were associated with a higher susceptibility to a recurrent sepsis episode. Furthermore, surgical sepsis patients with a higher number of organ dysfunctions and increased in-hospital mortality at day 28 and 90 showed lower serum zinc levels at admission. We report serum zinc levels as a promising biomarker in the diagnosis and evaluation of sepsis patients. However, it is still unclear whether these findings are caused by an over-amplified redistribution of zinc during acute-phase response, or whether the critically ill patients were zinc deficient before sepsis

The Human Host Defense Ribonucleases 1, 3 and 7 Are Elevated in Patients with Sepsis after Major Surgery - A Pilot Study

Sepsis is the most common cause of death in intensive care units and associated with widespread activation of host innate immunity responses. Ribonucleases (RNases) are important components of the innate immune system, however the role of RNases in sepsis has not been investigated. We evaluated serum levels of RNase 1, 3 and 7 in 20 surgical sepsis patients (Sepsis), nine surgical patients (Surgery) and 10 healthy controls (Healthy). RNase 1 and 3 were elevated in Sepsis compared to Surgery (2.2- and 3.1-fold, respectively; both p < 0.0001) or compared to Healthy (3.0- and 15.5-fold, respectively; both p < 0.0001). RNase 1 showed a high predictive value for the development of more than two organ failures (AUC 0.82, p = 0.01). Patients with renal dysfunction revealed higher RNase 1 levels than without renal dysfunction (p = 0.03). RNase 1 and 3 were higher in respiratory failure than without respiratory failure (p < 0.0001 and p = 0.02, respectively). RNase 7 was not detected in Healthy patients and only in two patients of Surgery, however RNase 7 was detected in 10 of 20 Sepsis patients. RNase 7 was higher in renal or metabolic failure than without failure (p = 0.04 and p = 0.02, respectively). In conclusion, RNase 1, 3 and 7 are secreted into serum under conditions with tissue injury, such as major surgery or sepsis. Thus, RNases might serve as laboratory parameters to diagnose and monitor organ failure in sepsis

Die Alternative zum fMRT: nonverbale Arzt-Patienten-Interaktion sichtbar machen mit der zweigriffigen Baumsäge

Myocardial dysfunction in sepsis has been linked to inflammation caused by pathogen-associated molecular patterns (PAMPs) as well as by host danger-associated molecular patterns (DAMPs). These include soluble heparan sulfate (HS), which triggers the devastating consequences of the pro-inflammatory cascades in severe sepsis and septic shock. Thus, there is increasing interest in the development of anti-infective agents, with effectiveness against both PAMPs and DAMPs. We hypothesized that a synthetic antimicrobial peptide (peptide 19-2.5) inhibits inflammatory response in murine cardiomyocytes (HL-1 cells) stimulated with PAMPs, DAMPs or serum from patients with septic shock by reduction and/or neutralization of soluble HS. In the current study, our data indicate that the treatment with peptide 19-2.5 decreases the inflammatory response in HL-1 cells stimulated with either PAMPs or DAMPs. Furthermore, our work shows that soluble HS in serum from patients with Gram-negative or Gram-positive septic shock induces a strong pro-inflammatory response in HL-1 cells, which can be effectively blocked by peptide 19-2.5. Based on these findings, peptide 19-2.5 is a novel anti-inflammatory agent interacting with both PAMPs and DAMPs, suggesting peptide 19-2.5 may have the potential for further development as a broad-spectrum anti-inflammatory agent in sepsis-induced myocardial inflammation and dysfunction

Development of a recurrent sepsis episode in sepsis patients within 28 days after enrolment.

<p>Sepsis patients, who died within the first septic episode, were excluded from this subset analysis. Sequentially measured a) Total serum zinc, b) Procalcitonin (PCT) and c) C-reactive protein (CRP) levels at admission (TA) are shown as mean + SEM and analyzed by unpaired t-test followed by Bonferroni-Holm procedure for multiple comparison. Significant differences are indicated by * (= p ≤ 0.05).</p

Demographic characteristics of the study population.

<p>Demographic characteristics of the study population.</p

Characteristics of sepsis patients subdivided by in-hospital mortality, occurrence of a recurrent sepsis episode within 28days and source of sepsis.

<p>Characteristics of sepsis patients subdivided by in-hospital mortality, occurrence of a recurrent sepsis episode within 28days and source of sepsis.</p

In- hospital mortality of sepsis patients after 28 (a-c) and 90 days (d-f) of enrollment.

<p>Total serum zinc, Procalcitonin (PCT) and C-reactive protein (CRP) levels at admission (TA) are shown as mean ± SEM in survivors and non-survivors of sepsis. Significant differences are indicated by * (= p ≤ 0.05).</p

Total serum zinc, Procalcitonin (PCT) and C-reactive Protein (CRP) levels at admission (TA) divided by groups (a-c) or number of organ dysfunctions (d-f) among sepsis patients.

<p>Data are shown as mean + SEM and analyzed by one-way ANOVA followed by Dunnett’s post hoc test.</p