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. 2012 Jan 20:12:15.
doi: 10.1186/1471-2334-12-15.

Soluble RAGE as a severity marker in community acquired pneumonia associated sepsis

Rodrigo M Narvaez-Rivera  1 , Adrian Rendon, Mario C Salinas-Carmona, Adrian G Rosas-Taraco
Affiliations

Soluble RAGE as a severity marker in community acquired pneumonia associated sepsis

Rodrigo M Narvaez-Rivera et al. BMC Infect Dis. .

Abstract

Background: Community-acquired pneumonia (CAP) is considered the most important cause of death from infectious disease in developed countries. Severity assessment scores partially address the difficulties in identifying high-risk patients. A lack of specific and valid pathophysiologic severity markers affect early and effective sepsis therapy. HMGB-1, sRAGE and RAGE have been involved in sepsis and their potential as severity markers has been proposed. The aim of this study was to evaluate HMGB-1, RAGE and sRAGE levels in patients with CAP-associated sepsis and determine their possible association with clinical outcome.

Method: We evaluated 33 patients with CAP-associated sepsis admitted to the emergency room and followed in the medical wards. Severity assessment scores (CURB-65, PSI, APACHE II, SOFA) and serologic markers (HMGB-1, RAGE, sRAGE) were evaluated on admission.

Results: Thirty patients with a diagnosis of CAP-associated sepsis were enrolled in the study within 24 hours after admission. Fourteen (46.6%) had pandemic (H1N1) influenza A virus, 2 (6.6%) had seasonal influenza A and 14 other diagnoses. Of the patients in the study group, 16 (53.3%) had a fatal outcome. ARDS was observed in 17 (56.6%) and a total of 22 patients had severe sepsis on admission (73%). The SOFA score showed the greatest difference between surviving and non-surviving groups (P = .003) with similar results in ARDS patients (P = .005). sRAGE levels tended to be higher in non-surviving (P = .058) and ARDS patients (P = .058). Logistic regression modeling demonstrated that SOFA (P = .013) and sRAGE (P = .05) were the only variables that modified the probability of a fatal outcome.

Conclusion: The association of elevated sRAGE with a fatal outcome suggests that it may have an independent causal effect in CAP. SOFA scores were the only clinical factor with the ability to identify surviving and ARDS patients.

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Figures

Figure 1
Figure 1
Analysis of CURB-65 score, SOFA score, soluble RAGE, membrane RAGE and HMGB-1 levels in survival and non-survival patients. A) CURB-65 and B) SOFA scores were obtained using international protocols. C) Serological soluble RAGE and D) HMGB-1 levels were measured by ELISA. E) Membrane RAGE levels were analyzed by flow cytometry. Data represent the median and were analyzed using Mann Whitney U test.
Figure 2
Figure 2
Analysis of soluble RAGE and SOFA score in ARDS and non-ARDS patients. Data represent the median and were analyzed using Mann Whitney U test.
See this image and copyright information in PMC

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