Lipocalin 10 as a New Prognostic Biomarker in Sepsis-Induced Myocardial Dysfunction and Mortality: A Pilot Study

Abstract

Introduction. Sepsis-induced myocardial dysfunction (SIMD) is the most common complications of sepsis and septic shock with extremely high incidence and mortality. Lipocalin 10 (Lcn10) has recently been identified as a potential biomarker for heart failure, yet its relation to sepsis has not been investigated. The purpose of this study was to explore whether circulating Lcn10 could be used as a prognostic tool in patients with SIMD. Methods. In this single-center observational pilot study, seventy-five sepsis patients were enrolled after sepsis diagnosis or ICU admission (45.3% female, median age 60 years), and 35 patients (46.7%) developed myocardial dysfunction. Serum Lcn10 levels of septic patients were measured using the enzyme-linked immunosorbent assay (ELISA) at the time of admission. Other biomarkers of cardiac function and Lcn10 concentration were compared between SIMD and non-SIMD groups. Results. We observed that the median Lcn10 levels were 2.780 ng/mL in patients with SIMD and 2.075 ng/mL in patients without SIMD ( P < 0.05 ). The area under the receiver operating characteristic (ROC) curve for the diagnosis of SIMD was 0.797 ( P < 0.05 ). In addition, elevated serum Lcn10 levels at the time of admission were positively associated with 28-day mortality in septic patients. Conclusions. Our study indicates that circulating Lcn10 levels may serve as a novel biomarker for the diagnosis and prognosis of myocardial dysfunction induced by sepsis. An additional large multicenter study may be warranted to confirm the findings of this study.

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“…Compared to non-SIC patients, SIC patients showed higher SOFA and APACHE II scores, as well as higher levels of CK-MB, BNP, TnI, lactate, and PCT. This conclusion was consistent with those presented in earlier studies [ 48 – 52 ]. RAAS was stimulated and the Ang II levels are elevated during the initial sepsis stages [ 53 ].…”

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“…Lipocalin (LCN) family proteins are small proteins (18–40 kDa) expressed in numerous tissues and involved in multiple processes (i.e., inflammation, detoxification, and immune activation) by transporting hydrophobic molecules (e.g., steroids, retinoids, or lipids) to cells [ 12 ]. Some members of this family of proteins such as lipocalin-2 (also known as neutrophil gelatinase-associated lipocalin) are considered acute phase proteins showing increases in inflammation [ 13 ].…”

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“…However, our study has several limitations. Firstly, due to the lack of a universally accepted definition of SIC, the inclusion criteria for the current project referenced a study from Mayo Clinic ( 19 ), which may require further investigation to accurately identify the population affected by SIC. Secondly, biomarker values were measured at a single time point, limiting insights into the dynamic immune response in SIC over time.…”

“…The inclusion criteria were (1) diagnosis of SIC based on a previous study ( 19 ): meeting the diagnostic definition of sepsis-3 ( 1 ); (2) LVEF <50%, or plasma hs-TnI > 0.78 ng/mL (normal range, 0–0.78 ng/mL) or NT-proBNP >500 pg/mL; (3) male sex; and (4) age between 18 and 80 years. The exclusion criteria were (1) previous diagnosis of cancer; (2) previously existing grade III-IV heart failure (New York Heart Association Classification); (3) dropped out during the 90 days follow-up, excluding death; (4) patients with missing data.…”