Pentraxin 3 in patients with severe sepsis or shock: the ALBIOS trial. (14th December 2016)

• Record Type: Journal Article
• Authors: Caironi, Pietro; Masson, Serge; Mauri, Tommaso; Bottazzi, Barbara; Leone, Roberto; Magnoli, Michela; Barlera, Simona; Mamprin, Filippo; Fedele, Andrea; Mantovani, Alberto; Tognoni, Gianni; Pesenti, Antonio; Gattinoni, Luciano; Latini, Roberto
• Other Names: Bruzzone Paola investigator.; Pagan Francesca investigator.; Russo Riccarda investigator.; Confalonieri Andrea investigator.; Abbruzzese Chiara investigator.; Vergnano Beatrice investigator.; Faenza Stefano investigator.; Siniscalchi Antonio investigator.; Pierucci Elisabetta investigator.; Noto Andrea investigator.; Pezzi Angelo investigator.; Spanu Paolo investigator.; Parrini Vieri investigator.; Oggioni Roberto investigator.; Pasetti Giovanni Stefano investigator.; Casadio Maria Cinzia investigator.; Buontempo Rosa investigator.; Carrer Sara investigator.; Piccoli Francesca investigator.; Rizzi Tatiana investigator.; Caricato Anselmo investigator.; La Sala Monica investigator.; Antonaci Alessandra investigator.; Fassini Paola investigator.; Paganini Silvia investigator.; Porta Virginia investigator.; Moise Gabriella investigator.; Marell Silvia investigator.; Furia Mirella investigator.; Urbano Maria Cristina investigator.; Carobbi Roberta investigator.; Poleni Simona investigator.; Kandil Hassan investigator.; Ballotta Andrea investigator.; Bettini Fabrizio investigator.; Sanseverino Manlio investigator.; Gatta Alessandro investigator.; Cecchini Francesca investigator.; Guatteri Luca investigator.; Ciceri Gabriella investigator.; Raimondi Ferdinando investigator.; Colombo Roberto investigator.; Ferraris Sandra investigator.; Borelli Massimo investigator.; Bellato Valentina investigator.; Cancellieri Franco investigator.; Senni Silvia investigator.; Bertocchi Ester investigator.; Ferri Paola investigator.; Moioli Gianpietro investigator.; Molin Alexandra investigator.; Salati Giovanni investigator.; Salsi Pierpaolo investigator.; Brunori Emanuela investigator.; Elisei Daniele investigator.; Maggio Giuseppe investigator.; Nicola Federico Guardia investigator.; Cavana Marco investigator.; Morelli Giacomo investigator.; Guarino Arturo investigator.; Isetta Michele investigator.; Tulli Giorgio investigator.; Mangani Valerio investigator.; Rossi Nicola investigator.; Ferrari Marta investigator.; Bona Francesco investigator.; Vay Monica investigator.; Bartoli Teresa investigator.; Gallo Mauro investigator.; Vettoretto Katiuscia investigator.; Della Morte Mauro investigator.; Boselli Enrico investigator.; Puscio Daniela investigator.; Bovo Monia investigator.; Galzerano Antonio investigator.; Carli Manuela investigator.; Zagara Giovanni investigator.;
• Is Part Of: European journal of clinical investigation. Volume 47:Number 1(2017)
• Page Start: 73
• Page End: 83
• Publication Date: 2016-12-14
• Subjects: Albumin -- pentraxin 3 -- prognosis -- septic shock -- severe sepsis; Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.12704
• Languages: English
• ISSNs: 0014-2972

Abstract

Abstract: Background: The long pentraxin PTX3 is a key component of the humoral arm of innate immunity related to sepsis severity and mortality. We evaluated the clinical and prognostic significance of circulating PTX3 in the largest cohort ever reported of patients with severe sepsis or septic shock. Materials and methods: Plasma PTX3 was measured on days 1, 2 and 7 after randomization of 958 patients to albumin or crystalloids for fluid resuscitation in the multicentre Albumin Italian Outcome Sepsis (ALBIOS) trial. We tested the association of PTX3 and its changes over time with clinical severity, prevalent and incident organ dysfunctions, 90‐day mortality and treatment. Results: PTX3 was high at baseline (72 [33–186] ng/mL) and rose with the severity and number of organ dysfunctions ( P < 0·001) and the incidence of subsequent new failures. The PTX3 concentration dropped from day 1 to 7, but this decrease was less pronounced in patients with septic shock ( P = 0·0004). Higher concentrations of PTX3 on day 1 predicted incident organ dysfunctions. Albumin supplementation was associated with lower levels of PTX3 in patients with septic shock ( P = 0·005) but not in those without shock. In a fully adjusted multivariable model, PTX3 on day 7 predicted 90‐day mortality. Smaller drops in PTX3 predicted higher 90‐day mortality. Conclusions: In severe sepsis and septic shock, early high PTX3 predict subsequent new organ failures, while a smaller drop in circulating PTX3 over time predicts an increased risk of death. Patients with septic shock show lower levels of PTX3 when assigned to albumin than to crystalloids.