Early depletion of contact system in patients with sepsis : a prospective matched control observational study

Berkestedt, Ingrid (author): Lund University,Lunds universitet,Kritiska infektioner,Forskargrupper vid Lunds universitet,Critical infections,Lund University Research Groups,Skåne University Hospital

Andersson, Pia (author): Lund University,Lunds universitet,Host parasite interactions,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital

Herwald, Heiko (author): Lund University,Lunds universitet,Host parasite interactions,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital

Valik, John Karlsson (author): Karolinska Institutet,Karolinska Institute,Karolinska University Hospital

Bodelsson, Mikael (author): Lund University,Lunds universitet,Kritiska infektioner,Forskargrupper vid Lunds universitet,Critical infections,Lund University Research Groups,Skåne University Hospital

(creator_code:org_t)

Related links:: http://dx.doi.org/10...; show more...; https://lup.lub.lu.s...; https://doi.org/10.1...; http://kipublication...; show less...

Abstract Subject headings

Activation of the contact system generates bradykinin from high-molecular-weight kininogen and has been suggested to participate in the pathophysiology of sepsis. To test this, we prospectively measured bradykinin and high-molecular-weight kininogen levels in a cohort of sepsis patients requiring intensive care. From 29 patients meeting criteria for sepsis or septic shock according to Sepsis-3, blood was sampled within 24 h and on the fourth day following admittance to intensive care. Patients planned for neurosurgery served as matched controls. Sequential organ failure assessment score and 90-day mortality was registered. Bradykinin levels (median [interquartile range]) were lower in sepsis patients (79 [62–172] pg/ml) compared to controls (130 [86–255] pg/ml, p < 0.025) and did not correlate with mortality or severity of circulatory derangement. High-molecular-weight kininogen levels were lower in sepsis patients (1.6 [0.8–4.8] densitometry units) compared to controls (4.4 [2.9–7.7] densitometry units, p < 0.001), suggesting previous contact system activation. High-molecular-weight kininogen levels were lower in non-survivors than survivors (p = 0.003) and negatively correlated to severity of circulatory derangement. We conclude that a role for bradykinin in later stages of severe sepsis must be challenged. Low high-molecular-weight kininogen concentrations suggest that the decrease in bradykinin is due to substrate depletion.

By the author/editor: Berkestedt, Ingr ...; Andersson, Pia; Herwald, Heiko; Valik, John Karl ...; Sörensen, Ola; Bodelsson, Mikae ...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Infectious Medic ...

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