Lorente Leonardo, Martín María M, Abreu-González Pedro, Domínguez-Rodriguez Alberto, Labarta Lorenzo, Díaz César, Solé-Violán Jordi, Ferreres José, Cabrera Judith, Igeño Jose Carlos, Jiménez Alejandro
Crit Care. 2013 Dec 11;17(6):R290. doi: 10.1186/cc13155.
There is a hyperoxidative state in sepsis. The objective of this study was to determine serum malondialdehyde (MDA) levels during the first week of follow up, whether such levels are associated with severity during the first week and whether non-surviving patients showed higher MDA levels than survivors during the first week.
We performed an observational, prospective, multicenter study in six Spanish Intensive Care Units. Serum levels of MDA were measured in 328 patients (215 survivors and 113 non-survivors) with severe sepsis at days one, four and eight of diagnosis, and in 100 healthy controls. The primary endpoint was 30-day mortality and the secondary endpoint was six -month mortality. The association between continuous variables was carried out using Spearman's rank correlation coefficient. Cox regression analysis was applied to determine the independent contribution of serum MDA levels on the prediction of 30-day and 6-month mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated as measures of the clinical impact of the predictor variables.
We found higher serum MDA in septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001) of diagnosis than in healthy controls. Serum MDA was lower in surviving than non-surviving septic patients at day one (p < 0.001), day four (p < 0.001) and day eight (p < 0.001). Serum MDA levels were positively correlated with lactic acid and SOFA during the first week. Finally, serum MDA levels were associated with 30-day mortality (HR = 1.05; 95% CI = 1.02-1.09; p = 0.005) and six-month mortality (hazard ratio (HR) = 1.05; 95% CI = 1.02-1.09; p = 0.003) after controlling for lactic acid levels, acute physiology and chronic health evaluation (APACHE)-II, diabetes mellitus, bloodstream infection and chronic renal failure.
To our knowledge, this is the largest series providing data on the oxidative state in septic patients to date. The novel finding is that high serum MDA levels sustained throughout the first week of follow up were associated with severity and mortality in septic patients.
脓毒症存在高氧化状态。本研究的目的是确定随访第一周期间血清丙二醛（MDA）水平，这些水平是否与第一周的严重程度相关，以及非存活患者在第一周的MDA水平是否高于存活患者。
我们在六个西班牙重症监护病房进行了一项观察性、前瞻性、多中心研究。在328例严重脓毒症患者（215例存活者和113例非存活者）诊断后的第1天、第4天和第8天以及100例健康对照者中测量血清MDA水平。主要终点是30天死亡率，次要终点是6个月死亡率。连续变量之间的关联采用Spearman等级相关系数进行分析。应用Cox回归分析来确定血清MDA水平对30天和6个月死亡率预测的独立贡献。计算风险比（HR）和95%置信区间（CI）作为预测变量临床影响的指标。
我们发现脓毒症患者在诊断后的第1天（p<0.001）、第4天（p<0.001）和第8天（p<0.001）的血清MDA水平高于健康对照者。存活脓毒症患者在第1天（p<0.001）、第4天（p<0.001）和第8天（p<0.001）的血清MDA水平低于非存活患者。第一周期间血清MDA水平与乳酸和序贯器官衰竭评估（SOFA）呈正相关。最后，在控制乳酸水平、急性生理与慢性健康状况评分系统（APACHE）-II、糖尿病、血流感染和慢性肾衰竭后，血清MDA水平与30天死亡率（HR = 1.05；95% CI = 1.02 - 1.09；p = 0.005）和6个月死亡率（风险比（HR）= 1.05；95% CI = 1.02 - 1.09；p = 0.003）相关。
据我们所知，这是迄今为止提供脓毒症患者氧化状态数据的最大系列研究。新发现是随访第一周期间持续的高血清MDA水平与脓毒症患者的严重程度和死亡率相关。
