Diagnostic and prognostic value of plasma gelsolin in multiorgan failure in patients with sepsis

Abstract

AIM: The aim of this work is to investigate the clinical value of gelsolin plasma concentration in the diagnosis of sepsis and investigate the relationship between gelsolin plasma concentration and the severity of organ dysfunction assessed by the acute physiology and chronic health evaluation (APACHE II) and SOFA scores, and to study the mortality predictive power of gelsolin plasma concentration. METHODS: We analyzed data of patients admitted with sepsis (n = 46) for 5 days. Age-and sex-matched non-specific intensive care unit (ICU) patients (n = 18) served as controls. Septic patients were then divided according to severity of disease to patients with sepsis, severe sepsis, and septic shock. Besides plasma gelsolin (pGSN) classical laboratory parameters and clinical scores (APACHE II and SOFA) were also assessed. RESULTS: Septic patients showed significantly decreased 1st-day GSN levels (170.9 ± 74.3 mg/l) compared to non-septic critically ill patients (225.9 ± 84.5 mg/l, p < 0.05). Furthermore, patients with septic shock had lower gelsolin plasma concentration than with severe sepsis and with sepsis (p < 0.05); furthermore, non-survivors had significantly lower GSN levels compared to survivors (p < 0.05). Septic patients had higher APACHE II and SOFA scores. Lower GSN level was significantly correlated with the development of multiple organ dysfunction syndrome and fatal outcome, also, patients with lower GSN level had longer ICU stay, APACHE II, and SOFA scores. APACHE II score has shown best ability to predict mortality with AUC 0.913 followed by PCT with AUC 0.828. pGSN was the least in the ability to predict mortality with AUC only 0.378 despite significant difference between pGSN levels between survivals and non-survivals. CONCLUSIONS: pGSN might serve as efficient complementary marker in sepsis. However, the prognostic role of pGSN in mortality requires further investigation in larger studies.