Plasma antioxidant potential in severe sepsis

Cowley, Hugh; Bacon, Pamela; Goode, Helen F.; Webster, Nigel R.; Jones, J.G.; Menon, DK

doi:10.1097/00003246-199607000-00019

Cited by 182 publications

(40 citation statements)

References 26 publications

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“…The present study contrasts with the findings of Cowley et al [34] who found antioxidant levels to be higher in survivors than non-survivors of severe sepsis at 5–7 days following ICU admission. This may reflect differences in the patient cohort as none of the patients in the study by Cowley et al had surgical intervention for sepsis.…”

Section: Discussioncontrasting

confidence: 99%

“…Levels of the antioxidants SOD and catalase were found to be significantly reduced in patients with peritonitis in keeping with previous reports [34]. However, GSH-Px levels did not differ from healthy controls in the present study but were reduced in previous studies on septic patients [18, 35, 36].…”

Section: Discussionsupporting

confidence: 92%

“…This may reflect differences in the patient cohort as none of the patients in the study by Cowley et al had surgical intervention for sepsis. Antioxidant levels return to baseline within 12 h of elective surgery [34], but with emergency surgery for peritonitis a persistent post-operative inflammatory response would be anticipated. Patients with complications following surgery for peritonitis may have been anticipated to have reduced antioxidant levels as with the non-survivors in the study by Cowley et al No such differences were noted possibly related to the wide range of post-operative levels.…”

Section: Discussionmentioning

confidence: 99%

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Free Radical and Antioxidant Levels in Patients with Secondary Peritonitis and Their Prognostic Significance

2007

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Background: The clinical outcome of patients with secondary bacterial peritonitis depends on the production of superoxides involved in bacterial killing and the endogenous level of antioxidants. The prognostic significance of their levels has not previously been investigated. Patients and Methods: Forty-five patients undergoing surgery for secondary peritonitis were prospectively evaluated. Severity of illness at admission (APACHE II score) was correlated with admission levels of superoxide radicals and antioxidants (superoxide dismutase (SOD), catalase and glutathione peroxidase). Levels were compared with general surgery controls (n = 10). Superoxide and antioxidant levels at admission (day 1) and post-operative days 3 and 5/7 were then correlated with outcome. Results: Nine of the 45 patients died (20% mortality) and 17 patients had complications (47% morbidity). The mean APACHE II score on admission was significantly higher among non-survivors than survivors (p < 0.01). The APACHE II score on admission correlated with the level of free radicals (r = 0.477, p < 0.01), catalase (r = –0.489, p < 0.01) and SOD (r = –0.357, p < 0.05). Admission superoxide levels were higher and antioxidant levels lower in peritonitis patients than controls. Levels did not significantly change following surgical intervention and post-operative levels did not correlate with outcome. Conclusion: The levels of superoxide and antioxidants correlate with the severity of illness on admission in patients with secondary peritonitis, but serial levels following surgical intervention do not predict outcome.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Free Radical and Antioxidant Levels in Patients with Secondary Peritonitis and Their Prognostic Significance

2007

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“…However, studies in adult population have shown contradictory results. Both lower [11] and higher [12][13][14] plasmatic antioxidant capacity have been reported in adult patients with SIRS and sepsis. These contradictory results can be explained by differences in the studied sample (total plasma, deproteinized plasma, or serum) and by the particular laboratory technique, which determines the relative contribution of each plasmatic antioxidant to the total antioxidant capacity [14].…”

Section: Discussionmentioning

confidence: 99%

Oxidative stress biomarkers in pediatric sepsis: a prospective observational pilot study

et al. 2016

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Objectives: Oxidative stress is known to participate in the progression of sepsis. Definite data regarding the behavior of oxidative stress biomarkers in pediatric sepsis is still lacking. This study hypothesized that oxidative stress occurs in pediatric sepsis and that the magnitude of the redox derangement is associated with worse clinical progression. Methods: Forty-two previously healthy pediatric patients with sepsis and a group of control subjects were included. Oxidative stress and inflammatory activity biomarkers were determined in blood samples. Patients were prospectively followed until their discharge or death. Results: Patients with non-severe and severe sepsis showed higher levels of plasmatic antioxidant capacity, lower erythrocyte thiol index, lower superoxide dismutase and catalase activities, higher glutathione peroxidase activity, and higher plasmatic F 2 -isoprostanes concentration than controls. Patients with severe sepsis had higher NF-kappaB activation than those with non-severe sepsis. Although we observed changes in some biomarkers in patients with worse clinical evolution, the explored biomarkers did not correlate with clinical estimators of outcome. Discussion: Oxidative stress occurs in pediatric sepsis, resulting in oxidative damage. The explored biomarkers are not useful as outcome predictors in the studied population. The behavior of these biomarkers still needs to be addressed in broader groups of pediatric patients with sepsis.

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“…Despite endogenous anti-oxidant systems, this state feeds-forward in a self-sustaining fashion, amplifying individual organ failure and immune dysregulation. Of note, the degree of ‘oxidative stress’ (as measured in the plasma compartment) has been reported to influence outcome in critical illness(186, 187). As noted above, attempts to treat oxidative stress (quenchers: Vitamins A, C and E, melatonin, N-acetyl cysteine, glutamine; enzyme inhibitors: allopurinol, various NOS inhibitors; chelators: defuroxamine) have largely failed translation from model systems and case series to clinical trials.…”

Section: Anti-oxidant Therapiesmentioning

confidence: 99%

Pediatric Multiple Organ Dysfunction Syndrome: Promising Therapies

Doctor

Zimmerman

Agus

et al. 2017

Pediatric Critical Care Medicine

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Objective To describe the state of the science, identify knowledge gaps, and offer potential future research questions regarding promising therapies for children with multiple organ dysfunction syndrome (MODS) presented during the Eunice Kennedy Shriver National Institute of Child Health and Human Development Workshop on Pediatric Multiple Organ Dysfunction Syndrome (March 26-27, 2015). Data Sources Literature review, research data, and expert opinion. Study Selection Not applicable. Data Extraction Moderated by an expert from the field, issues relevant to the association of MODS with a variety of conditions were presented, discussed and debated with a focus on identifying knowledge gaps and research priorities. Data Synthesis Summary of presentations and discussion supported and supplemented by relevant literature. Conclusions Among critically ill children, MODS is relatively common and associated with significant morbidity and mortality. For outcomes to improve, effective therapies aimed at preventing and treating this condition must be discovered and rigorously evaluated. In this manuscript, a number of potential opportunities to enhance current care are highlighted including the need for a better understanding of the pharmacokinetics and pharmacodynamics of medications, the effect of early and optimized nutrition, and the impact of effective glucose control in the setting of MODS. Additionally, a handful of the promising therapies either currently being implemented or developed are described. These include extracorporeal therapies, anti-cytokine therapies, anti-toxin treatments, anti-oxidant approaches and multiple forms of exogenous steroids. For the field to advance, these and other therapies must be assessed in rigorous manner and implemented accordingly.

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Plasma antioxidant potential in severe sepsis

Cited by 182 publications

References 26 publications

Free Radical and Antioxidant Levels in Patients with Secondary Peritonitis and Their Prognostic Significance

Free Radical and Antioxidant Levels in Patients with Secondary Peritonitis and Their Prognostic Significance

Oxidative stress biomarkers in pediatric sepsis: a prospective observational pilot study

Pediatric Multiple Organ Dysfunction Syndrome: Promising Therapies

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