Soluble RAGE as a severity marker in community acquired pneumonia associated sepsis

BMC Infect Dis. 2012 Jan 20;12:15. doi: 10.1186/1471-2334-12-15.

Abstract

Background: Community-acquired pneumonia (CAP) is considered the most important cause of death from infectious disease in developed countries. Severity assessment scores partially address the difficulties in identifying high-risk patients. A lack of specific and valid pathophysiologic severity markers affect early and effective sepsis therapy. HMGB-1, sRAGE and RAGE have been involved in sepsis and their potential as severity markers has been proposed. The aim of this study was to evaluate HMGB-1, RAGE and sRAGE levels in patients with CAP-associated sepsis and determine their possible association with clinical outcome.

Method: We evaluated 33 patients with CAP-associated sepsis admitted to the emergency room and followed in the medical wards. Severity assessment scores (CURB-65, PSI, APACHE II, SOFA) and serologic markers (HMGB-1, RAGE, sRAGE) were evaluated on admission.

Results: Thirty patients with a diagnosis of CAP-associated sepsis were enrolled in the study within 24 hours after admission. Fourteen (46.6%) had pandemic (H1N1) influenza A virus, 2 (6.6%) had seasonal influenza A and 14 other diagnoses. Of the patients in the study group, 16 (53.3%) had a fatal outcome. ARDS was observed in 17 (56.6%) and a total of 22 patients had severe sepsis on admission (73%). The SOFA score showed the greatest difference between surviving and non-surviving groups (P = .003) with similar results in ARDS patients (P = .005). sRAGE levels tended to be higher in non-surviving (P = .058) and ARDS patients (P = .058). Logistic regression modeling demonstrated that SOFA (P = .013) and sRAGE (P = .05) were the only variables that modified the probability of a fatal outcome.

Conclusion: The association of elevated sRAGE with a fatal outcome suggests that it may have an independent causal effect in CAP. SOFA scores were the only clinical factor with the ability to identify surviving and ARDS patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood*
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / mortality
  • Community-Acquired Infections / pathology*
  • Female
  • Humans
  • Influenza A virus
  • Male
  • Middle Aged
  • Pneumonia, Bacterial / complications*
  • Pneumonia, Bacterial / mortality
  • Pneumonia, Bacterial / pathology*
  • Prognosis
  • Receptor for Advanced Glycation End Products / blood*
  • Sepsis / diagnosis
  • Sepsis / mortality
  • Sepsis / pathology*
  • Severity of Illness Index*

Substances

  • Biomarkers
  • Receptor for Advanced Glycation End Products