Evaluation of Fibronectin and C-Reactive Protein Levels in Patients with Sepsis: A Case-Control Study

  • Mojgan Mamani Department of Infectious Diseases, Hamedan University of Medical Sciences, Hamedan, Iran.
  • Seyyed Hamid Hashemi Department of Infectious Diseases, Hamedan University of Medical Sciences, Hamedan, Iran.
  • Mehrdad Hajilooi Department of Immunology, Hamedan University of Medical Sciences, Hamedan, Iran.
  • Farnaz Saedi Student Research Center, Hamedan University of Medical Sciences, Hamedan, Iran.
  • Amin Niayesh Student Research Center, Hamedan University of Medical Sciences, Hamedan, Iran.
  • Mohammad Fallah Basic Science Research Center, Faculty of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran.
Keywords:
C-reactive protein, Fibronectin, Sepsis

Abstract

Sepsis is a significant health problem with an estimated 750,000 new cases in the USA annually. It is also the third leading cause of death in developed countries, equaling the number of fatalities from acute myocardial infarction. The high sepsis-related mortalities mean there is an urgent need to improve the diagnosis and management of sepsis patients. The aim of this study was the evaluation of fibronectin and Creactive protein (CRP) plasma levels in patients with sepsis and other infectious diseases without sepsis. In a case-control study, 90 patients with sepsis and 90 patients with other infectious diseases without sepsis were studied. Serum levels of fibronectin and CRP were measured. The data were analyzed by SPSS version 15. The mean levels of fibronectin in the cases and controls were 288.97±89.10 mg/l and 341.24±110.53 mg/l respectively (P=0.001). The mean levels of CRP in the cases and controls were 89.42±54.05 µg/ml and 27.42±25.89 µg/ml respectively (P<0.001). Concerning the source of infection, the mean CRP levels were significantly higher in septic patients with urinary tract infection, pneumonia, and soft tissue infection (P<0.001). Decreased levels of fibronectin and increased levels of CRP may be considered as reliable diagnostic markers for sepsis. Also, CRP could be a better predictive factor for sepsis than fibronectin.

References

Balk RA, Bone RC. The septic syndrome. Definition and clinical implications. Crit Care Clin 1989;5(1):1-8.

Ayres SM. SCCM's new horizons conference on sepsis and septic shock. Crit Care Med 1985;13(10):864-6.

Centers for Disease Control (CDC). Increase in National Hospital Discharge Survey rates for septicemia: United States, 1979-1987. MMWR Morb Mortal Wkly Rep 1990;39(2):31-4.

Parrillo JE, Parker MM, Natanson C, Suffredini AF, Danner RL, Cunnion RE, Ognibene FP. Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med 1990;113(3):227-42.

Manship L, McMillin RD, Brown JJ. The influence of sepsis and multisystem and organ failure on mortality in the surgical intensive care unit. Am Surg 1984;50(2):94-101.

Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA. Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med 1989;17(5):389-93.

Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med 2006;34(1):15-21.

Bone RC. Toward an epidemiology and natural history of SIRS (systemic inflammatory response syndrome). JAMA 1992;268(24):3452-5.

Munford RS. Sever sepsis and septic shock. In: Fauci AS, Kasper DL, Longo DL, Braunwald E, Haucer SL, Jameson JL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008. p.1695-702.

Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D; Sepsis Occurrence in Acutely Ill Patients Investigators. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006;34(2):344-53.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31(4):1250-6.

Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987;317(11):653-8.

Ziegler EJ, Fisher CJ Jr, Sprung CL, Straube RC, Sadoff JC, Foulke GE, Wortel CH, Fink MP, Dellinger RP, Teng NN, et al. Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebocontrolled trial. The HA-1A Sepsis Study Group. N Engl J Med 1991;324(7):429-36.

Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA. Sepsis syndrome: a valid clinical entity. Methylprednisolone Severe Sepsis Study Group. Crit Care Med 1989;17(5):389-93.

Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34(6):1589-96.

Zambon M, Ceola M, Almeida-de-Castro R, Gullo A, Vincent JL. Implementation of the Surviving Sepsis Campaign guidelines for severe sepsis and septic shock: we could go faster. J Crit Care 2008;23(4):455-60.

Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 1992;101(6):1481-3.

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20(6):864-74.

Marshall JC, Reinhart K; International Sepsis Forum. Biomarkers of sepsis. Crit Care Med 2009;37(7):2290-8.

Pepys MB, Baltz ML. Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid A protein. Adv Immunol 1983;34:141-212.

Póvoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, Sabino H. C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect 2005;11(2):101-8.

Póvoa P, Almeida E, Moreira P, Fernandes A, Mealha R, Aragão A, Sabino H. C-reactive protein as an indicator of sepsis. Intensive Care Med 1998;24(10):1052-6.

Okamura JM, Miyagi JM, Terada K, Hokama Y. Potential= clinical applications of C-reactive protein. J Clin Lab Anal 1990;4(3):231-5.

Skarnes RC. In vivo distribution and detoxification of endotoxins . In: Berry LJ, editor. Handbook of Endotoxin. Vol. 3. Amsterdam: Elsevier Science Publishers; 1985. p. 56-81.

Dyke MP, Forsyth KD. Decreased plasma fibronectin concentrations in preterm infants with septicaemia. Arch Dis Child 1993;68:557-60.

Ruiz Martín G, Prieto Prieto J, Veiga de Cabo J, Gomez Lus L, Barberán J, González Landa JM, Fernández C. Plasma fibronectin as a marker of sepsis. Int J Infect Dis 2004;8(4):236-43.

Eriksen HO, Molke-Jensen F, Clemmensen I. Plasma fibronectin concentration in patients admitted to intensive care unit. Haematologia (Budap) 1984;17(1):93-100.

O'Connell MT, Becker DM, Steele BW, Peterson GS, Hellman RL. Plasma fibronectin in medical ICU patients. Crit Care Med 1984;12(6):479-82.

Pierrakos C, Vincent JL. Sepsis biomarkers: a review. CritCare 2010;14(1):R15.

Brodin B, Briheim G, Cederblad G, Maller R, Schildt B, Ohman S. Plasma fibronectin concentration in suspected septicaemia is related to severity of sepsis. Acta Chir Scand 1986;152:721-6.

O'Connell MT, Becker DM, Steele BW, Peterson GS, Hellman RL. Plasma fibronectin in medical ICU patients. Crit Care Med 1984;12(6):479-82.

Rubli E, Büssard S, Frei E, Lundsgaard-Hansen P, Pappova E. Plasma fibronectin and associated variables in surgical intensive care patients. Ann Surg 1983;197(3):310-7.

Gerdes JS, Polin RA. Sepsis screen in neonates with evaluation of plasma fibronectin. Pediatr Infect Dis J 1987;6(5):443-6.

Polin RA. Role of fibronectin in diseases of newborn infants and children. Rev Infect Dis 1990;12 Suppl 4:S428-38.

Yentis SM, Soni N, Sheldon J. C-reactive protein as an indicator of resolution of sepsis in the intensive care unit. Intensive Care Med 1995;21(7):602-5.

Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998;102(4):E41.

Matson A, Soni N, Sheldon J. C-reactive protein as a diagnostic test of sepsis in the critically ill. Anaesth Intensive Care 1991;19(2):182-6.

Mardi D, Fwity B, Lobmann R, Ambrosch A. Mean cell volume of neutrophils and monocytes compared with Creactive protein, interleukin-6 and white blood cell count for prediction of sepsis and nonsystemic bacterial infections. Int J Lab Hematol 2010;32(4):410-8.

Keshet R, Boursi B, Maoz R, Shnell M, Guzner-Gur H. Diagnostic and prognostic significance of serum C-reactive protein levels in patients admitted to the department of medicine. Am J Med Sci 2009;337(4):248-55.

Waliullah SM, Islam MN, Siddika M, Hossain MA, Jahan I, Chowdhury AK. Evaluation of simple hematological screen for early diagnosis of neonatal sepsis. Mymensingh Med J 2010;19(1):41-7.

dos Anjos BL, Grotto HZ. Evaluation of C-reactive protein and serum amyloid A in the detection of inflammatory and infectious diseases in children. Clin Chem Lab Med 2010;48(4):493-9.

How to Cite
1.
Mamani M, Hashemi SH, Hajilooi M, Saedi F, Niayesh A, Fallah M. Evaluation of Fibronectin and C-Reactive Protein Levels in Patients with Sepsis: A Case-Control Study. Acta Med Iran. 50(6):404-410.
Section
Articles