Biomarkers of endothelial dysfunction predict sepsis mortality in young infants: a matched?case-control study

摘要

Reducing death due to neonatal sepsis is a global health priority, however there are limited tools to facilitate early recognition and treatment. We hypothesized that measuring circulating biomarkers of endothelial function and integrity (i.e. Angiopoietin-Tie2 axis) would identify young infants with sepsis and predict their clinical outcome. We conducted a matched case-control (1:3) study of 98 young infants aged 0–59?days of life presenting to a referral hospital in Bangladesh with suspected sepsis. Plasma levels of Ang-1, Ang-2, sICAM-1, and sVCAM-1 concentrations were measured at admission. The primary outcome was mortality (n?=?18); the secondary outcome was bacteremia (n?=?10). Ang-2 concentrations at presentation were higher among infants who subsequently died of sepsis compared to survivors (aOR 2.50, p?=?0.024). Compared to surviving control infants, the Ang-2:Ang-1 ratio was higher among infants who died (aOR 2.29, p?=?0.016) and in infants with bacteremia (aOR 5.72, p?=?0.041), and there was an increased odds of death across Ang-2:Ang-1 ratio tertiles (aOR 4.82, p?=?0.013). This study provides new evidence linking the Angiopoietin-Tie2 pathway with mortality and bacteremia in young infants with suspected sepsis. If validated in additional studies, markers of the angiopoietin-Tie2 axis may have clinical utility in risk?stratification of infants with suspected sepsis.