Sustained high serum malondialdehyde levels are associated with severity and mortality in septic patients

被引:55
|
作者
Lorente, Leonardo [1 ]
Martin, Maria M. [2 ]
Abreu-Gonzalez, Pedro [3 ]
Dominguez-Rodriguez, Alberto [4 ]
Labarta, Lorenzo [5 ]
Diaz, Cesar [6 ]
Sole-Violan, Jordi [7 ]
Ferreres, Jose [8 ]
Cabrera, Judith [1 ]
Carlos Igeno, Jose [2 ]
Jimenez, Alejandro [9 ]
机构
[1] Hosp Univ Canarias, Intens Care Unit, San Cristobal la Laguna 38320, Santa Cruz De T, Spain
[2] Hosp Univ Nuestra Senora Candelaria, Intens Care Unit, Santa Cruz De Tenerife 38010, Spain
[3] Univ La Laguna, Dept Phisiol, Fac Med, San Cristobal la Laguna 38320, Santa Cruz De T, Spain
[4] Hosp Univ Canarias, Dept Cardiol, San Cristobal la Laguna 38320, Santa Cruz De T, Spain
[5] Hosp San Jorge Huesca, Intens Care Unit, Huesca 22004, Spain
[6] Hosp Insular, Intens Care Unit, Las Palmas Gran Canaria 35016, Spain
[7] Univ Hosp, Intens Care Unit, Las Palmas Gran Canaria 35010, Spain
[8] Univ Valencia, Intens Care Unit, Hosp Clin, Valencia 46004, Spain
[9] Hosp Univ Canarias, Res Unit, San Cristobal la Laguna 38320, Santa Cruz De T, Spain
来源
CRITICAL CARE | 2013年 / 17卷 / 06期
关键词
MITOCHONDRIAL DYSFUNCTION; ANTIOXIDANT THERAPY; MELATONIN TREATMENT; LIPID-PEROXIDATION; SEPSIS; PROTECTS; SHOCK; ACID;
D O I
10.1186/cc13155
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: There is a hyperoxidative state in sepsis. The objective of this study was to determine serum malondialdehyde (MDA) levels during the first week of follow up, whether such levels are associated with severity during the first week and whether non-surviving patients showed higher MDA levels than survivors during the first week. Methods: We performed an observational, prospective, multicenter study in six Spanish Intensive Care Units. Serum levels of MDA were measured in 328 patients (215 survivors and 113 non-survivors) with severe sepsis at days one, four and eight of diagnosis, and in 100 healthy controls. The primary endpoint was 30-day mortality and the secondary endpoint was six-month mortality. The association between continuous variables was carried out using Spearman's rank correlation coefficient. Cox regression analysis was applied to determine the independent contribution of serum MDA levels on the prediction of 30-day and 6-month mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated as measures of the clinical impact of the predictor variables. Results: We found higher serum MDA in septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001) of diagnosis than in healthy controls. Serum MDA was lower in surviving than non-surviving septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001). Serum MDA levels were positively correlated with lactic acid and SOFA during the first week. Finally, serum MDA levels were associated with 30-day mortality (HR = 1.05; 95% CI = 1.02-1.09; p = 0.005) and six-month mortality (hazard ratio (HR) = 1.05; 95% CI = 1.02-1.09; p = 0.003) after controlling for lactic acid levels, acute physiology and chronic health evaluation (APACHE)-II, diabetes mellitus, bloodstream infection and chronic renal failure. Conclusions: To our knowledge, this is the largest series providing data on the oxidative state in septic patients to date. The novel finding is that high serum MDA levels sustained throughout the first week of follow up were associated with severity and mortality in septic patients.
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页数:11
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