Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients

Background Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. Methods Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. Results There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11 center dot 53, 95 per cent c.i. 4 center dot 15 to 32 center dot 08; P = 0 center dot 006) and the best area under the curve (AUC) for detecting sepsis (0 center dot 86, 95 per cent c.i. 0 center dot 80 to 0 center dot 91; P < 0 center dot 001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8 center dot 09, 1 center dot 34 to 48 center dot 91; P = 0 center dot 028) and lipocalin 2 (OR 6 center dot 62, 2 center dot 47 to 17 center dot 77; P = 0 center dot 002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0 center dot 81, 0 center dot 73 to 0 center dot 90; P < 0 center dot 001). Conclusion MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection.