EVALUATION OF PROGNOSTIC SIGNIFICANCE FOR BIOCHEMICAL MARKERS OF OXIDATIVE STRESS, ENDOGENOUS INTOXICATION AND VASCULAR REGULATION IN THE DEVELOPMENT OF UNFAVORABLE OUTCOMES IN PATIENTS WITH SEPSIS

Background. Due to the significant infectious complications mortality, the search for prognostic biochemical markers of sepsis development in critically ill patients is relevant.

Material and methods. The study involved 57 patients; in 40 cases sepsis developed. The control group included 17 patients where sepsis did not develop. The study was performed on day 1–2, 5–7 and 10–12 after admission. The intensity of oxidative stress was assessed by the level of malondialdehyde (MDA) and total antioxidant activity of blood serum (TAA). The endogenous intoxication was assessed by the concentration of medium molecular weight peptides (MMWPs), total and effective albumin concentration (TAC, EAC) in serum. The disturbance of endogenous vascular regulation was assessed by the level of stable metabolites of nitric oxide (NOx) in serum and the concentration of angiotensin converting enzyme (ACE).

Results. It has been found that MDA may be a prognostic index of poor outcome on day 5–7 after admission (relative risk (RR)=1.141, confidence interval (CI) 95% (1.033; 1.259), р=0.09); NOx level may be a predictor of a poor outcome on day 1–2 (RR=1.026, CI 95% (0.999; 1.055), р=0.064), as well as on day 10–12 (RR=1.012, CI 95% (1.000; 1.023), р=0.098) together with ACE concentration (RR=1.034, CI 95% (1.007; 1.062), р=0.015); MMWP254 level (RR=11.195, CI 95% (1.571; 79.771), р=0.016) and MMWP280 level (RR=17.370, CI 95% (1.568; 192.455), р=0.02) are significant predictors of a poor outcome on day 1–2 and 5–7 as well (MMWP254 — RR=4626.791, CI 95% (7.903; 27808.629), р=0.009 and MMWP280 — RR=1331.590, CI 95% (5.006; 354179.342), р=0.012).

Conclusion. We identified prognostically significant signs of unfavorable outcomes of septic process: decrease in NOx; growth of ACE concentration; increase in MDA and decrease in TAA; increase in MMWPs; decrease in TAC and EAC.

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