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Dadun > Depósito Académico > CIMA (Centro de Investigación Médica Aplicada) > Área de Ciencias Cardiovasculares > Aterosclerosis e inflamación > DA - CIMA - Cardiovasculares - Aterosclerosis e inflamación - Artículos de revista >

Matrix metalloproteinase-9, -10, and tissue inhibitor of matrix metalloproteinases-1 blood levels as biomarkers of severity and mortality in sepsis
Authors: Lorente, L. (Leonardo)
Martin, M.M. (María M.)
Labarta, L. (Lorenzo)
Diaz, C. (César)
Sole-Violan, J. (Jordi)
Blanquer, J. (José)
Orbe, J. (Josune)
Rodriguez, J.A. (José Antonio)
Jimenez, A. (Alejandro)
Borreguero-Leon, J.M. (Juan M.)
Belmonte, F. (Felipe)
Medina, J.C. (Juan C.)
Llimiñana, M.C. (María C.)
Ferrer-Agüero, J.M. (José M.)
Ferreres, J. (José)
Mora, M.L. (María L.)
Lubillo, S. (Santiago)
Sanchez, M. (Manuel)
Barrios, Y. (Ysamar)
Sierra, A. (Antonio)
Paramo, J.A. (José Antonio)
Keywords: Matrix metalloproteinase 10/blood
Matrix metalloproteinase 9/blood
Sepsis/mortality
Sepsis/physiopathology
Severity of illness Index
Tissue inhibitor of metalloproteinase-1/blood
Issue Date: 2009
Publisher: BioMed Central
Publisher version: http://ccforum.com/content/13/5/R158
ISSN: 1466-609X
Citation: Lorente L, Martin MM, Labarta L, Diaz C, Sole-Violan J, Blanquer J, et al. Matrix metalloproteinase-9, -10, and tissue inhibitor of matrix metalloproteinases-1 blood levels as biomarkers of severity and mortality in sepsis. Crit Care 2009;13(5):R158.
Abstract
INTRODUCTION: Matrix metalloproteinases (MMPs) play a role in infectious diseases through extracellular matrix (ECM) degradation, which favors the migration of immune cells from the bloodstream to sites of inflammation. Although higher levels of MMP-9 and tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) have been found in small series of patients with sepsis, MMP-10 levels have not been studied in this setting. The objective of this study was to determine the predictive value of MMP-9, MMP-10, and TIMP-1 on clinical severity and mortality in a large series of patients with severe sepsis. METHODS: This was a multicenter, observational, and prospective study carried out in six Spanish Intensive Care Units. We included 192 (125 surviving and 67 nonsurviving) patients with severe sepsis and 50 age- and sex-matched healthy controls in the study. Serum levels of MMP-9, MMP-10, TIMP-1, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-10 were measured in patients with severe sepsis at the time of diagnosis and in healthy controls. RESULTS: Sepsis patients had higher levels of MMP-10 and TIMP-1, higher MMP-10/TIMP-1 ratios, and lower MMP-9/TIMP-1 ratios than did healthy controls (P < 0.001). An association was found between MMP-9, MMP-10, TIMP-1, and MMP-9/TIMP-1 ratios and parameters of sepsis severity, assessed by the SOFA score, the APACHE-II score, lactic acid, platelet count, and markers of coagulopathy. Nonsurviving sepsis patients had lower levels of MMP-9 (P = 0.037), higher levels of TIMP-1 (P < 0.001), lower MMP-9/TIMP-1 ratio (P = 0.003), higher levels of IL-10 (P < 0.001), and lower TNF-alpha/IL-10 ratio than did surviving patients. An association was found between MMP-9, MMP-10, and TIMP-1 levels, and TNF-alpha and IL-10 levels. The risk of death in sepsis patients with TIMP-1 values greater than 531 ng/ml was 80% higher than that in patients with lower values (RR = 1.80; 95% CI = 1.13 to 2.87;P = 0.01; sensitivity = 0.73; specificity = 0.45). CONCLUSIONS: The novel findings of our study on patients with severe sepsis (to our knowledge, the largest series reporting data about MMP levels in sepsis) are that reduced MMP-9/TIMP-1 ratios and increased MMP-10 levels may be of great pathophysiologic significance in terms of severity and mortality, and that TIMP-1 levels may represent a biomarker to predict the clinical outcome of patients with sepsis.
Permanent link: http://hdl.handle.net/10171/22256
Appears in Collections:DA - CIMA - Cardiovasculares - Aterosclerosis e inflamación - Artículos de revista

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