Beneficial effects of the heme oxygenase-1/carbon monoxide system in patients with severe sepsis/septic shock

Intensive Care Med. 2010 Jan;36(1):42-8. doi: 10.1007/s00134-009-1575-4. Epub 2009 Sep 29.


Purpose: We evaluated the relations among the arterial carbon monoxide (CO) concentration, heme oxygenase (HO)-1 expression by monocytes, oxidative stress, plasma levels of cytokines and bilirubin, and the outcome of patients with severe sepsis or septic shock.

Methods: Thirty-six patients who fulfilled the criteria for severe sepsis or septic shock and 21 other patients without sepsis during their stay in the intensive care unit were studied. HO-1 protein expression by monocytes, arterial CO, oxidative stress, bilirubin, and cytokines were measured.

Results: Arterial blood CO, cytokine, and bilirubin levels, and monocyte HO-1 protein expression were higher in patients with severe sepsis/septic shock than in non-septic patients. Increased HO-1 expression was related to the arterial CO concentration and oxidative stress. There was a positive correlation between survival and increased HO-1 protein expression or a higher CO level.

Conclusions: Arterial CO and monocyte HO-1 protein expression were increased in critically ill patients, particularly those with severe sepsis or septic shock, suggesting that oxidative stress is closely related to HO-1 expression. The HO-1/CO system may play an important role in sepsis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 8-Hydroxy-2'-Deoxyguanosine
  • Aged
  • Bilirubin / metabolism
  • Carbon Monoxide / metabolism*
  • Critical Care / methods
  • Deoxyguanosine / analogs & derivatives
  • Deoxyguanosine / genetics
  • Deoxyguanosine / metabolism
  • Female
  • Heme Oxygenase-1 / genetics
  • Heme Oxygenase-1 / metabolism*
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Interleukin-1beta / blood
  • Interleukin-6 / blood
  • Interleukin-8 / blood
  • Male
  • Oxidative Stress / physiology
  • Severity of Illness Index
  • Shock, Septic / epidemiology
  • Shock, Septic / metabolism*
  • Shock, Septic / physiopathology*


  • Interleukin-1beta
  • Interleukin-6
  • Interleukin-8
  • Carbon Monoxide
  • 8-Hydroxy-2'-Deoxyguanosine
  • Heme Oxygenase-1
  • Deoxyguanosine
  • Bilirubin